What is your current practice for de-escalation of frequency of administration of bispecific antibodies among responders in patients with relapsed/refractory multiple myeloma?

This is a great question. Since the majority of patients respond, I'm not clear of the PFS benefit derived from maintaining dose intensity in patients with ≤ partial response.

The majority of the data regarding de-escalation is from single-arm or registration trials that were not designed to discover the "right" BsAb dose. This is unfortunate, but since I am not covering the costs of these trials, who am I to throw stones? We know that better clinical outcomes correlate with

• Significant drop in CD19+ circulating B-cells [Emb-06 data]
• Higher baseline total T-cell counts in the periphery, lower proportion of immunosuppressive regulatory T cells (Tregs), T cells expressing co-inhibitory receptors (CD38, PD-1, and PD-1/TIM-3), and soluble BCMA ...