P-119: Treatment Outcomes of Primary vs. Referred Patients with Multiple Myeloma Receiving Talquetamab or Teclistamab

Introduction: Recent approval of bispecific t-cell engagers (BiTEs) provides novel treatment options with impressive response rates and durability in the relapsed/refractory multiple myeloma (MM) setting. These therapies require Risk Evaluation and Mitigation Strategies (REMS) training and requirements for monitoring and management of cytokine release syndrome (CRS) and neurotoxicity (NT) that may not be available to community providers. To overcome these barriers, we created partnerships allowing patients to receive initial step-up dosing at the University of Rochester Medical Center (URMC) along with ongoing telemedicine visits to help manage toxicities as patients returned to referring providers for continued therapy post step-up.

We sought to understand the impact of these partnerships on outcomes of primary academic versus referral patients with a goal of reaching underserved populations and achieving similar outcomes for all patients.

Methods: We identified patients using prescription data for teclistamab or talquetamab. Patient and disease characteristics were collected using manual chart extraction and included creatinine (Cr), hemoglobin (Hgb), disease state (free light chains and paraprotein levels), lines of prior therapy, time from diagnosis to first dose, race and age. Zip codes for the patient’s primary address classified them as urban versus rural using the website Rural Health Information Hub (https://www.ruralhealthinfo.org). Rate and grade of CRS and NT, number of hospitalizations, progression free survival (PFS) and overall survival (OS) in patients receiving talquetamab or teclistamab from the time of FDA approval through December 31, 2024, were assessed through May 17, 2024. Referred patients who did not receive therapy were excluded, these patients were either too ill to receive therapy or chose not to receive therapy. Continuous variables were compared via the non-parametric Wilcoxon rank-sum test, categorical variables with Fisher’s exact test and OS and PFS were compared using the log-rank test.

Results: Data was collected on 43 patients. Rural zip codes were significantly higher in referred (N=20) than primary (N=23) patients (p=0.048). Hgb levels were significantly higher in primary patients (p=0.04) at therapy initiation. Referred patients tended to be older and with more advanced disease as found by higher Cr, FLC and paraprotein values, though there was insufficient evidence of a difference between the groups at an alpha=0.05 level. Secondary hospitalization rates between the groups were similar and no referral patients required a return to Rochester after discharge. There was insufficient evidence of a difference in the OS and PFS between the groups, these will be updated for longer follow-up. Updated hospitalizations will be collected for future analysis.

Conclusions: Results suggest partnerships between academic and community providers can expand access of novel therapies to underserved, rural patients without increased toxicity or compromised patient outcomes.