Bispecific Toxicity Management

This page provides resources for the management of CRS and ICANS which are associated with bispecific therapies. 

Guidelines and Education Documents

Agent Specific Education

Tarlatamab: How-to Website: please view if caring for a patient receiving tarlatamab

Discharge Criteria

Discharge Criteria for Patients Receiving Bispecific Antibody Therapy

*These are meant to serve as a general guideline for approach to discharge*

1. No grade 2 or higher Cytokine Release Syndrome (CRS) in past 24 hours.

2. Patients with persistent grade 1 CRS (recurrent fevers) can be discharged if:

2. • No CRS/ICANS intervention in the past 24 hours (i.e. dexamethasone, tocilizumab, fluid boluses, oxygen supplementation, or pressors)

   • Stable fever curve and no new CRS symptoms

   • Heart rate <120

   • At least 24 hours of observation from first sign of CRS

   • Alternative diagnoses have been considered and ruled out or assessed as unlikely (such as new infection).

3. Patient assessed by inpatient medical team as well appearing or at baseline, and medically fit for discharge.

4. Patient assessed by inpatient medical team as reliable, willing, and able to seek out immediate care should they worsen after discharge, such as developing:

   • New symptoms

   • Neutropenic fever: ≥100.5.

   • Worsening non-neutropenic fever: higher, more frequent, or not responding to acetaminophen

   • Heart rate ≥120

   • Shortness of breath or Pulse ox ≤90%

   • Hypotension with SBP ≤90 or 20 points below SBP baseline