Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy Guidelines


Authors: Crombie, J. L.; Graff, T.; Falchi, L.; Karimi, Y. H.; Bannerji, R.; Nastoupil, L.; Thieblemont, C.; Ursu, R.; Bartlett, N.; Nachar, V.; Weiss, J.; Osterson, J.; Patel, K.; Brody, J.; Abramson, J. S.; Lunning, M.; Shah, N. N.; Ayed, A.; Kamdar, M.; Parsons, B.; Caimi, P.; Flinn, I.; Herrera, A.; Sharman, J.; McKenna, M.; Armand, P.; Kahl, B.; Smith, S.; Zelenetz, A.; Budde, L. E.; Hutchings, M.; Phillips, T.; Dickinson, M.
Title: Consensus recommendations on the management of toxicity associated with CD3×CD20 bispecific antibody therapy
Abstract: Bispecific antibodies (BsAb) that target CD3 and CD20 represent a new milestone in the treatment of patients with B-cell non-Hodgkin lymphoma. These drugs have demonstrated remarkable single-agent activity in patients with heavily pretreated disease, and 3 drugs have so far received regulatory approvals in various countries. However, BsAbs can potentially lead to severe toxicity associated with T-cell activation, particularly cytokine release syndrome (CRS). The anticipated widespread use of these off-the-shelf products poses challenges for implementation and highlights the need for guidance in anticipating, mitigating, and managing adverse events. In clinical trials, guidance for the evaluation and treatment of CRS and neurotoxicity associated with BsAb therapy has been modeled after algorithms originally created for chimeric antigen receptor (CAR) T-cell therapies and other immune effector therapies, yet notable differences in timing, quality, and severity exist between the toxicities of BsAbs and CAR T-cell therapies. We therefore convened an international panel of academic and community practice physicians, advanced practitioners, registered nurses, and pharmacists with experience using CD3×CD20 BsAbs in clinical trial and off-trial settings to provide comprehensive, consensus-based recommendations specific to the assessment and management of CD3×CD20 BsAb–related toxicities. © 2024 American Society of Hematology
Keywords: consensus; lymphocyte activation; adoptive immunotherapy; immunotherapy, adoptive; antibodies, bispecific; bispecific antibody; humans; human
Journal Title: Blood
Volume: 143
Issue: 16
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2024-04-18
Start Page: 1565
End Page: 1575
Language: English
DOI: 10.1182/blood.2023022432
PUBMED: 38252906
PROVIDER: scopus
DOI/URL:
Notes: Note -- Source: Scopus
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  1. Andrew D Zelenetz
    767 Zelenetz
  2. Lorenzo Falchi
    107 Falchi