The introduction of chimeric antigen receptor T (CAR-T) cell and bispecific antibody (BsAb) therapies has revolutionized multiple myeloma (MM) treatment, offering exceptional efficacy, and culminating in recent regulatory approval. However, these therapies have brought unique toxicity challenges, manifesting not only with the well-established cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), but also with the emergence of other common and equally distinctive toxicities, including cytopenias, hypogammaglobulinemia, infections, and the rare but life-threatening immune effector cell-like lymphohistiocytosis syndrome (IEC-HS). These adverse events are characterized by unique mechanisms of action that differ from those of previous treatments for MM, thereby requiring specialized knowledge to optimize day-to-day management and ultimately maximize therapeutic benefits while ensuring patient safety. Additionally, the toxicity profiles of these T-cell engager therapies are becoming increasingly important in treatment decisions, with implications for patient selection and therapy sequencing. In this review, we provide a comprehensive overview of the current state-of-the-art regarding the incidence, etiopathogenetic mechanisms, and clinical manifestations of these increasingly less non-prototypical but still lesser-known side effects than CRS and ICANS, in order to offer clear and actionable insights into their effective management, while emphasizing critical points for future improvement, in view of the increasing number of MM patients who will benefit from the newly approved and upcoming immunotherapies.
嵌合抗原受体T细胞（CAR-T）和双特异性抗体（BsAb）疗法的引入，彻底改变了多发性骨髓瘤（MM）的治疗格局，其卓越疗效已获得近期监管批准。然而，这些疗法也带来了独特的毒性挑战，不仅表现为已明确的细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS），还出现了其他常见且同样具有特征性的毒性反应，包括血细胞减少、低丙种球蛋白血症、感染以及罕见但危及生命的免疫效应细胞样淋巴组织细胞增生综合征（IEC-HS）。这些不良事件的作用机制独特，与既往MM治疗方案不同，因此需要专业知识进行优化日常管理，在确保患者安全的同时最大化治疗获益。此外，这些T细胞衔接疗法在治疗决策中的毒性特征日益重要，影响着患者选择和治疗顺序。本综述全面概述了这些日益常见但仍较CRS和ICANS认知不足的副作用的发生率、病因机制及临床表现，旨在为其有效管理提供清晰可行的见解，同时强调未来改进的关键点，以应对即将受益于新近获批及未来免疫疗法的MM患者数量不断增长的现状。
肿瘤(癌症)患者之家