Conference Abstracts - 2026 National Summit on Hematologic Cancers
Vol. 6, Issue Supplement 2, 2026 · S1-2
Healthcare Resource Utilization and Cost Implications of Outpatient Bispecific Antibody Step-Up Dosing in Relapsed/Refractory Multiple Myeloma: A Real-World Experience from a Large Academic Center
Phyu Thin Naing, MD,Bhagirathbhai Dholaria, MD,Bryanna Reinhardt, MD,Kathryn Kennedy, APRN,Leslie Mader, RN,Sarah Moseley, RN,Eden Biltibo, MD,Reena Jayani, MD,Callee Brooks, PharmD,James Jerkins, MD,Bipin Savani, MD,Adetola Kassim, MD,Sarah Profitt, PharmD,Muhamed Baljevic, MD
Submission received: 2026-08-16 / Accepted: 2026-08-25 / Published: 2026-10-02
Abstract
Background
Bispecific antibodies (BsAbs) have transformed management of multiple myeloma (RRMM). FDA labeling recommends inpatient (IP) 48 hour hospitalization during step-up dosing (SUD) for teclistamab(Tec) and talquetamab (Tal). Outpatient (OP) SUD pathways are emerging but remain limited in adoption. We evaluated feasibility, safety, and healthcare resource utilization associated with OP BsAb SUD at a large academic center.
Methods
We performed a retrospective analysis among patients (pts) who received Tec or Tal SUD for RRMM at Vanderbilt University Medical Center between 5/2023-1/2026. Demographics, SUD setting, hospitalization days, cytokine release syndrome(CRS)/ immune effector cell-associated neurotoxicity syndrome (ICANS) incidence and management data were analyzed. Estimated hospitalization charges were calculated using published National Inpatient multiple myeloma hospitalization data by Solangi, Z., et al. (2024). Medication margin estimates (OP vs IP) were derived using published report by Puttkammer et al. (2025).
Results
Fifty-one pts underwent 58 BsAb SUD treatments, including 34 Tec (58.6%) and 24 Tal (41.4%); 7 patients received both agents at different timepoints. Thirty-four (58.6%) SUD events were IP, 24 (41.4%) were OP (20 fully OP and 4 hybrid). Median (range) hospitalization duration was 8 (6–12) days for IP and 0 days (0–5) for OP delivery. Overall, 306 hospitalization days were potentially avoidable, including 20 days of grade (G)1 CRS management. Using a cost estimate of $16,240 per hospitalization day, $4.97 million was potentially avoidable hospitalization charges. Additional healthcare savings were associated with the administration of high-cost medications [Tec, Tal, and tocilizumab (Toci)] in the OP vs IP setting. Overall, 120 IP (78 Tec, 42 Tal) and 13 Toci doses were administered which would have yielded an estimated additional cost margin savings of $0.5 million with full OP delivery. The total estimated potential healthcare savings could be $5.5 million across the study cohort. ORR was 76.4% for Tec and 87.5% for Talq; ≥VGPR in 67.6% of Tec and 54.2% of Talq. CRS occurred in 31(53.4%) SUD events, with G2 CRS in 7(12.1%) and ICANS in 8 (14.3%) dosing events, all G1. No G3 toxicity observed with OP SUD.
Conclusion
In our analysis, full OP BsAb SUD in RRMM was feasible and safe. Full OP Tec/Tal SUD delivery with OP G1 CRS management yields marked reductions in healthcare utilization. These findings support broader adoption of OP SUD pathways and prospective studies to define monitoring and admission criteria as BsAbs utlization in myeloma continue to expand across all phases.