Bispecific T-cell engager

Background

• Recombinant proteins that bind to two different antigens, one of which activates T cells and the other binds a cancer target
• Used in treating some hematologic malignancies

Safety

Adverse Effects

• Some of the most serious adverse effects include cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome
  • Usually within days of first dose
• Causes hypogammaglobulinemia that can last months to years
• Most patients develop some neutropenia, which can last weeks
• Infections are common, mostly bacterial and viral and occasionally fungal
  • Bacterial pneumonia is most common
  • COVID-19, with prolonged course
  • EBV and CMV, cases of JCV

Screening

• Consider baseline HIV, EBV, CMV, hepatitis B, and hepatitis C serologies

Antimicrobial Prophylaxis

• Unclear role for antibiotics and antifungals, in general
• Likely PJP and VZV prophylaxis for duration of treatment