Chair & Presenter, Beth Faiman, PhD, MSN, APN-BC, AOCN, BMTCN, FAAN, FAPO, Donna D. Catamero, ANP-BC, OCN, CCRC, and Tiffany A. Richards, PhD, ANP-BC, AOCNP, prepared useful Practice Aids pertaining to multiple myeloma for this NCPD/ILNA activity titled “Betting on BCMA in Multiple Myeloma: Oncology Nurse Principles for Delivering Effective Care With BCMA Antibodies and Cellular Therapy.” For the full presentation, downloadable Practice Aids, and complete NCPD/ILNA information, and to apply for credit, please visit us at https://bit.ly/3ZSymre. NCPD/ILNA credit will be available until May 27, 2024.

1. The Spectrum of Multiple Myeloma
Disease Categories, Testing, and Treatment
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
Image courtesy of Beth Faiman.
Premalignant Malignant
MGUS SMM Active MM
Low-risk
MGUS
High-risk
MGUS
Low-risk
SMM
High-risk
SMM
Ultra–
high-risk
SMM
Early
active
Active
Treating
Testing
Subcategories
SPEP/UPEP spike from
normal; abnormal free
light chain results;
bone marrow plasma
cells <10%
SPEP/UPEP
spike of ≥2 g/dL;
free light chain
ratio ≥20; bone
marrow plasma
cells ≥20%
Myeloma-defining
events; free light
chain ratio ≥100;
bone marrow plasma
cells ≥60%; CrCl <40
mL/min; ≥2 lesions
CRAB criteria:
Calcium elevation
Renal dysfunction
Anemia
Bone lesions
Monitor Clinical Trial Treat

2. Nursing Tools, Strategies, and Take-Homes
for Multiple Myeloma Patient Management
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
Bone health changes
• Monitor for changes in bone health
• Supplement with vitamin D and calcium
• Determine if bone-modifying drugs are needed
• Schedule regular dental examinations if patients are on bone-modifying therapies
• Determine if patients are at high risk for infection (eg, patients with hypogammaglobulinemia)
• Monitor for neutropenia and myelosuppression
• Administer shingles prophylaxis when treating with proteasome inhibitors, monoclonal antibodies,
or cellular therapies
• Administer IVIG for recurrent infections
• Assess for diarrhea when treating with bortezomib and lenalidomide
• Assess for constipation when treating with thalidomide and doxorubicin
• Administer an antiemetic prior to treating with carfilzomib, selinexor, doxorubicin, or proteasome inhibitors
• Monitor for PN when treating with bortezomib and thalidomide; promptly intervene to prevent
irreversible PN
• Avoid renal-toxic agents
• Administer 24-hour urine albumin (bone-modifying drugs)
• Dose reduce (lenalidomide, melphalan, opioids, acyclovir)
• Recommend healthy eating, moderating alcohol intake, and exercising
• Remind patients to keep checkup appointments
• Recommend patients stop smoking
• Recommend regular eye exams, especially if patients are on corticosteroids (because of the risk of
cataracts) or belantamab
• Communicate with and educate patients on: financial expectations, psychosocial issues, treatment
options, adherence to appointments, drugs, physical activity, and patient resources
• Perform monthly disease assessments and imaging as indicated
Infectious diseases
GI toxicities
Neurologic effects
Renal impairment
Disease monitoring
Health maintenance
Survivorship care
General Nursing Considerations to Address for All Patients1

3. Nursing Tools, Strategies, and Take-Homes
for Multiple Myeloma Patient Management
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
Predictor Acronym Score
Immunomodulatory drug
Body mass index ≥25 kg/m2
Pelvic, hip, or femur fracture
Erythropoiesis-stimulating agent
Doxorubicin
Dexamethasone
High dose
Low dose
4
2
Ethnicity/race of Asian/Pacific Islander
History of VTE before MM
Tunneled line/central venous catheter
Existing thromboprophylaxis: therapeutic LMWH or warfarin
I
M
P
E
D
4
1
4
1
3
E
V
T
E
-3
5
2
-4
Existing thromboprophylaxis: prophylactic LMWH or aspirin -3
IMPEDE VTE Risk Scoring Can Be Useful Prior to Deciding On Therapy2
VTE Risk Scores <3: low risk
3-6:
intermediate risk
>6: high risk
1. NCCN Clinical Practice Guidelines in Oncology. Multiple Myeloma. Version 3.2023. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. 2. Covut F et al. Br J Haematol. 2021;193:1213-1219.

4. Take-Homes on BCMA CAR-T Constructs
in Multiple Myeloma Treatment
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
1. Carvykti (ciltacabtagene autoleucel) Prescribing Information. https://www.fda.gov/media/156560/download. 2. Abecma (idecabtagene vicleucel) Prescribing Information. https://www.fda.gov/media/147055/download.
REMS
Cilta-Cel1
Approved in RRMM after ≥4
prior therapies, including an
anti-CD38 mAb, a proteasome
inhibitor, and an IMiD
Recommended Dose Range
0.5-1.0 × 106
CAR-positive viable T cells
(maximum dose of 1 × 108
CAR-positive viable T cells
per single-dose infusion)
Recommended Dose Range
300-460 × 106
CAR-positive viable T cells
Ide-Cel2
Approved in RRMM after ≥4
prior therapies, including an
anti-CD38 mAb, a proteasome
inhibitor, and an IMiD
General Principles for CAR-T Therapy
CAR-T Cell Therapy:
Indications and Dosing
Referral to a certified healthcare facility is required for collection of patient’s cells
and administration of CAR-T therapy
Avoid prophylactic use of dexamethasone or other systemic corticosteroids
Premedicate with acetaminophen and an H1 antihistamine
Monitor for CRS and ICANS and confirm tocilizumab availability before infusion
Ide-cel and cilta-cel are available only through a restricted program under a
Risk Evaluation and Mitigation Strategy (REMS)
Monitor for neurologic events, hemophagocytic lymphohistiocytosis/
macrophage activation syndrome, and cytopenias
Administer a lymphodepleting chemotherapy regimen of cyclophosphamide
and fludarabine before CAR-T infusion
Do not use a leukodepleting filter when administering

5. Antibody Therapy in Multiple Myeloma
Current Status, Dosing, and Practical Considerations
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
Regulatory
Status
Dosing
Select
Considerations
Phase 2 study in
patients with RRMM
and no prior BCMA-
targeted treatment2
Patients received
76 mg weekly with a
two-step-up priming
regimen per the
MagnetisMM-3 trial3
The most common AEs
were hematologic events
and CRS; the two-step-up
priming regimen is intended
to help mitigate the rate and
severity of CRS3
Elranatamab
BCMA x CD3
Phase 1 study
in patients with
RRMM
In early-phase testing,
dose escalation was
0.025-120 mg and
dose expansion was
60 mg
The most common
TEAEs were
neutropenia, anemia,
CRS, and fatigue
ABBV-3831
BCMA x CD3
Therapy/Target
Phase 1/2 study in
patients with RRMM4 200 mg5
The most common
grade 3/4 TEAEs were
hematologic; the most
frequent TEAEs were
fatigue and CRS (most CRS
events were grade 1)4
Linvoseltamab
BCMA x CD3

6. Antibody Therapy in Multiple Myeloma
Current Status, Dosing, and Practical Considerations
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
a
Currently available under accelerated approval.
1. D'Souza A et al. J Clin Oncol. 2022;40:3576-3586. 2. https://clinicaltrials.gov/ct2/show/NCT04649359. 3. Lesokhin A et al. ASCO 2022. Abstract 8006. 4. Zonder JA et al. EHA 2022. Abstract S189. 5. Bumma N et al. ASH 2022. Abstract 4555. 6. Tecvayli (teclistamab-cqyv) Prescribing
Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761291s000lbl.pdf. 7. Moreau P et al. ASH 2021. Abstract 896. 8. Wong SW et al. ASH 2022. Abstract 162.
Although the BCMA antibody–drug conjugate belamaf received FDA Accelerated Approval in 2020, the manufacturer has
initiated the process for withdrawal of the US marketing authorization based on findings from the DREAMM-3 phase 3
confirmatory trial
Other bispecific BCMA and non-BCMA agents are also in rapid development, including TNB383b, talquetamab,
cevostamab, and HPN 217
Other new developments: Alnuctamab is an emerging BCMA x CD3 antibody that has demonstrated clinical activity
in patients with RRMM who have been treated with ≥3 prior lines of therapy8
• Approved in RRMM
in patients who have
received ≥4 lines of prior
therapy, including an IMiD,
a proteasome inhibitor,
and an anti-CD38
antibody (FDA); also
approved by the European
Medicines Agency(see PI
for more information)
• Day 1: 0.06 mg/kg
SC injection
• Day 4: 0.3 mg/kg
• Day 7: 1.5 mg/kg
• Followed by 1.5 mg/
kg once weekly until
PD or unacceptable
toxicity
The most common AEs
were hematologic events
and CRS.
Note: ICANS events
occurred in 4 patients
but were all grade 1/2
and resolved without
discontinuation7
Teclistamab6,a
BCMA x CD3
Regulatory
Status
Dosing
Select
Considerations
Therapy/Target

7. Resources for Encouraging Patient Engagement in Care
From HealthTree Foundation for Multiple Myeloma
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SJV40
HealthTree Foundation for Multiple Myeloma offers a wide range of resources that can be used to
encourage patients to learn more about their disease or a planned course of treatment
Patient education and navigation tools
Programs that create patient
connections and build community
A living, real-world evidence data
portal that delivers researchers the
data they need to accelerate a cure
Scan to visit:
healthtree.org/myeloma
Scan to visit:
healthtree.org/myeloma/coach
Free one-on-one help from experienced
patients and caregivers
Help patients get answers
to basic questions about myeloma
Scan to visit:
healthtree.org/myeloma/university
Selected Resources