EHA 2026 | Transitioning bispecifics into community care for myeloma: recently published guidelines

We are here at the EHA 2026 annual meeting and it’s truly a very exciting era for the multiple myeloma community and for multiple myeloma patients. Obviously, we have a lot of innovations coming into the field. Antibody drug conjugates like Belantamab are really moving forward. We have now the release of the data about the novel CELMoDs, especially mezigdomide in combination with carfilzomib and dexamethasone in the Successor-2 trial. But I would say one of the key highlights from this meeting, but also from the ASCO 2026 annual meeting, is about the increasing use of bispecific antibodies, namely the BCMA-targeted T-cell engagers, which are now moving progressively from late relapse into earlier disease settings and earlier relapse. And obviously, the number of patients receiving these agents is going to increase. And of course, our goal is to make life easier for patients. And because these agents require regular administration initially every week, every other week, then every month. So we have to figure this out. But also we know very well that there is a crucial initial step called the step-up dosing. And this is exactly where the efforts are going now in this direction to try to make it simpler, to make it smoother, more tolerable. 

And I’m very pleased and proud that I have collaborated and led a European, a pan-European effort with more than 50 colleagues in order to design actually some easy to apply recommendations for the implementation of the use of bispecific antibodies in the outpatient setting, in the community setting. Because we know innovation is important, but it’s even more important to make it accessible to everybody and everywhere. And these guidelines were just published, actually, as an open-access peer-reviewed paper in the e-journal of hematology, so you can find it easily on the web. And the summary about these guidelines can be divided into different pieces. 

First of all, it’s about either the shared community care or completely in the community. Shared community care would be, for instance, you do your step-up dosing in the academic center, and then the patient is transferred into the local hospital. The full community care would be about having centers who are familiar with the use of these agents. So obviously, patient selection is a key issue. We have to make sure we’re not dealing with patients who are very frail, patients who have too many comorbidities, patients who are unstable from an infectious point of view, from a hemodynamic point of view. 

The second important point is about educating the patient, but also the healthcare professionals about the key complications like CRS, like ICANS, but also most importantly, the management of opportunistic infection. And this is why, obviously, the guidelines strongly recommend to make sure that there are very strict, very clear SOPs when it comes to the monitoring, but also the management of these infections. But also, we need to have collaboration, I would say, interactions between the academic center and these community hospitals to be always ready, actually, to manage whatever difficult situation that may occur. And we believe this model is feasible. We already know from different real world registries and studies that a substantial proportion of patients are now being treated in the community setting. And actually, the outcome is very reassuring. But it is obvious that we really need to stick to some very stringent guidelines and apply some strict rules because efficacy is extremely important when it comes to managing a disease like myeloma but safety is also very important, I would say even crucial. And please don’t forget the final outcome is about the combination of an excellent efficacy profile plus an excellent safety profile. And I’m very pleased how things are going these days.

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