Key Clinical Summary: 

• Design/Population: This multicenter retrospective analysis compared dexamethasone versus tocilizumab for initial management of low-grade CRS in patients receiving talquetamab for relapsed/refractory multiple myeloma.
• Key Outcomes: Dexamethasone was effective in resolving low-grade CRS without compromising myeloma response rates, though CRS recurrence with subsequent dosing was more common compared with tocilizumab.
• Clinical Relevance: Dexamethasone represents a practical, outpatient-friendly option for CRS management, supporting broader implementation of bispecific antibody therapies in multiple myeloma.

Donald Moore, PharmD, Atrium Health Levine Cancer Institute, Charlotte, North Carolina, discusses results from a multicenter retrospective analysis comparing dexamethasone versus tocilizumab for management of cytokine release syndrome (CRS) among patients receiving talquetamab for relapsed/refractory multiple myeloma. 

Dexamethasone was shown to be a feasible option for low-grade CRS, with no impact on treatment efficacy. These findings support the use of outpatient strategies to help manage CRS and facilitate bispecific antibody therapy delivery.

Dr Moore presented these results at the Hematology/Oncology Pharmacy Association (HOPA) Annual Meeting in New Orleans, Louisiana. 

Transcript: 

My name is Don Moore, and I’m the clinical oncology pharmacy manager at Atrium Health Levine Cancer Institute in Charlotte, North Carolina. I recently presented an abstract comparing dexamethasone versus tocilizumab for the treatment of cytokine release syndrome with talquetamab at the Hematology/Oncology Pharmacy Association (HOPA) Annual Conference in New Orleans, Louisiana, last week on March 26. 

Our study was a multicenter retrospective analysis across seven US academic medical centers that compared dexamethasone versus tocilizumab for the primary management of low-grade CRS with talquetamab for the treatment of relapsed/refractory multiple myeloma. This study, in a sense, was a follow-up to one that the same group had presented at HOPA last year and was subsequently published in Blood Cancer Journal, which asked the same question but with teclistamab, a bispecific antibody approved for the treatment of multiple myeloma. In that prior study, we saw that dexamethasone was a feasible initial treatment option compared to tocilizumab and potentially more practical in terms of outpatient delivery of bispecific antibody therapy, by being able to treat low-grade CRS at home. We also saw, importantly, no significant impact with additional dexamethasone on myeloma response rates, depth of response, or progression-free survival when used with that T cell–engaging bispecific antibody.

After seeing those results, we as a group wanted to confirm this with another bispecific antibody, which is why we looked at it with talquetamab. In this study, we compared patients who received initial management with dexamethasone versus those who received tocilizumab in patients treated with commercial talquetamab in routine standard of care. We saw a relatively heavily pretreated patient population, about a quarter of patients had received talquetamab as bridging therapy to CAR T-cell therapy.

What we found was that, particularly for grade 1 cytokine release syndrome, dexamethasone was a feasible treatment option. A single dose of dexamethasone resolved about 50% of grade 1 CRS cases, and another quarter resolved with an additional dose. The only really significant difference between the 2 cohorts was that there was more recurrence of CRS with subsequent step-up dosing in those who received dexamethasone as primary management versus those who received tocilizumab, which is likely due to the longer-acting nature of tocilizumab. However, all of those recurrences were of the same grade or lower and resolved with additional interventions such as dexamethasone. There were otherwise no significant differences in treatment delays to the next step-up dose between the 2 groups.

In terms of talquetamab efficacy, very importantly, we observed no significant differences in myeloma response rates or in the attainment of very good partial response or better between those who received dexamethasone versus tocilizumab as primary management for CRS. This helps confirm that additional dexamethasone was not blunting responses to talquetamab.

In conclusion, we found that dexamethasone can be a feasible treatment option for patients who develop grade 1 CRS with talquetamab. The concept of “pocket dex” may help facilitate outpatient delivery and monitoring of bispecific therapies in multiple myeloma.

Source: 

Moore D. Dexamethasone versus tocilizumab for management of tocilizumab-induced cytokine release syndrome in patients with relapsed/refractory multiple myeloma: A multicenter, retrospective study. Presented at the HOPA Annual Conference. March 25 - 27, 2026. New Orleans, Louisiana. CR07.