Ailawadhi, Sikander

PURPOSE Teclistamab is initiated with a step-up dosing (SUD) schedule to mitigate the risk of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). Early teclistamab users commonly received SUD in a hospital setting. This study aimed to evaluate safety and health care resource utilization (HRU) in real-world patients with multiple myeloma who initiated teclistamab SUD in an outpatient setting. METHODS This was a retrospective study using Mayo Clinic's electronic medical records from October 26, 2022, to October 31, 2023. Patient characteristics were summarized for all patients treated with teclistamab and separately for patients who started SUD outpatient. SUD pattern, safety, HRU, and post-SUD dosing schedule were described in patients with complete SUD. RESULTS At data cutoff, 65 patients received ≥1 teclistamab dose, including 58 patients who initiated SUD outpatient (median age, 69.2 years; male, 63.8%; White, 89.7%). Among 57 patients who completed SUD in an outpatient setting, all received premedications on the days of teclistamab administrations per label recommendation; 18 (31.6%) developed CRS (13 grade 1, four grade 2, and one grade 4) and two developed ICANS (one each with grade 2 and 4). All CRS and ICANS resolved with supportive care and all patients continued treatment. Eighteen patients were admitted to the hospital for CRS treatment, with a median CRS-related hospital stay of 2 days per admission. Most (60%) doses during SUD required <1 hour clinic time between administration and checkout. Post-SUD, clinic time for treatment doses decreased to <30 minutes for most doses (82%). CONCLUSION Outcomes of this study support outpatient administration as a safe and feasible option for teclistamab SUD to potentially reduce HRU and improve patient experiences.

Introduction: Myeloma therapeutics have tremendously improved in recent times, leading to unprecedented outcomes. Timely initiation of effective treatment is vital to improving survival and quality of life. Patient refusal to receive treatment is infrequent but certainly leads to increased morbidity/mortality. We studied factors associated with treatment refusal. Methods: The National Cancer Database (NCDB) was queried for adult patients diagnosed with MM between 2004-2021. Those who refused treatment for initial management despite physician's recommendation were identified. Patients with multiple primary malignancies or unknown treatment status were excluded. Patients' demographics and socioeconomic factors were collected. Kaplan-Meier and multivariate Cox regression were used to evaluate the likelihood of treatment refusal in the whole cohort and in each racial/ethnic group. Results: Out of 86,350 eligible patients with MM who were recommended to initiate therapy, 2,508 (2.9%) did not receive any treatment due to refusal. Of these, 52.6% were females, 64% were non-Hispanic White (NHW), 21.3% were non-Hispanic African American (NHAA), and 5.2% were Hispanic. On multivariate analysis, patients who were treated at comprehensive and integrated facilities were more likely to refuse treatment as compared to those at academic facilities (OR=1.36; 95% CI: 1.22-1.52, p&lt;0.001 and OR=1.22; 95% CI: 1.07-1.4, p=0.004, respectively). Patients on Medicare (OR=1.42; 95% CI: 1.16-1.73, p&lt;0.001), and presence of higher Charlson Comorbidity Index (CCI) also had a higher likelihood of refusing treatment. Lower refusal rates were seen for male gender (OR=0.83; 95% CI: 0.76-0.91, p&lt;0.001), NHW racial/ethnic group (as against NHAA; OR=0.34; 95% CI: 0.16-0.71, p=0.004), being insured (OR=0.69; 95% CI: 0.52-0.93, p=0.015), having private insurance (compared to Medicaid; OR=0.47; 95% CI: 0.38-0.59, p&lt;0.001) and having a higher income level (OR=0.82; 95% CI: 0.70-0.96, p=0.013). Among NHAA patients, 2.8% refused treatment and were more likely to have Medicare (OR=1.4; 95% CI: 1.03-1.9, p=0.032). Having private insurance (compared to Medicaid; OR=0.61; 95% CI: 0.43-0.88, p=0.008) had a lower likelihood of refusing treatment. Among NHW, 2.9% refused treatment and they were more likely to be treated at community, comprehensive and integrated facilities compared to academic facilities (OR=1.39; 95% CI: 1.12-1.73, p=0.003, OR=1.54; 95% CI: 1.33-1.77, p&lt;0.001 and OR=1.38; 95% CI: 1.16-1.64, p&lt;0.001, respectively), be from rural areas (OR=1.43; 95% CI: 1.05-1.96, p=0.025), and have a higher CCI. On the other hand, male gender (OR=0.79; 95% CI: 0.72-0.89, p&lt;0.001), private insurance (compared to Medicaid; OR=0.42; 95% CI: 0.30-0.59, p&lt;0.001) and higher income level (OR=0.80; 95% CI: 0.66-0.98, p=0.029) had a lower likelihood of refusing treatment. Among Hispanic patients, 2.3% refused treatment and were more likely to have Medicare (OR=1.96; 95% CI: 1.13-3.4, p=0.016), while those with private insurance (compared to Medicaid; OR=0.32; 95% CI: 0.14-0.73, p=0.007) had a lower likelihood of refusing treatment. Conclusions: This large real-world analysis highlights the intricate sociodemographic and economic factors that affect the decision of a MM to not proceed with the recommendation for treatment. (1) NHW are less likely to refuse treatment as compared to NHAA. (2) Insurance status is an important driver of refusal and transcends race/ethnicity. Furthermore, in this study, we highlight characteristics that are specific to different racial/ethnic groups like CCI which affect only certain racial/ethnic groups. This provides an opportunity to develop targeted interventions such that the benefit of therapeutic advancements can be realized by all.

Background: Venetoclax (Ven), a BCL2 inhibitor, has shown promising responses in multiple myeloma (MM) patients with t(11;14) and/or BCL2 expression. However, consistent benefit in clinical trials remain elusive. This report evaluates the efficacy and safety of Ven combination therapies, including in the non-t(11;14) subgroup, and examines the impact of secondary cytogenetic abnormalities (SGA) on outcomes. Methods: This retrospective study included multiple myeloma (MM) patients without concurrent AL amyloidosis treated with Ven-based combinations at Mayo Clinic sites from January 2015 to December 2023. FISH data was collected at diagnosis and before venetoclax initiation to assess SGAs. Refractoriness was defined by progression on or within 60 days of stopping treatment. Patients refractory to at least one proteasome inhibitor (PI), immunomodulatory drug (ImiD), and anti-CD38 antibody were considered triple-class refractory (TCR). Ven combinations were grouped as: Daratumumab/CD38 antibody (Dara)-Ven based if received Dara ± other drugs, PI-Ven-based without Dara, Ven-dexamethasone (Ven-d), and other combinations (Ven-Misc). BCL2 expression in patients without t(11;14) was determined by immunohistochemistry (IHC). Progression-free survival (PFS) was calculated from treatment initiation to disease progression or last follow-up. Results: We included 232 patients in this study. The median age at diagnosis of MM was 62 years (range 32-87), and the median age at initiation was 68 years (range 35-89). The median time from diagnosis of MM to initiation of Ven was 55 months (95% CI 28, 89 months), and the median follow-up from initiation of Ven-based treatment was 17.2 months (95% CI: 14, 22). Patients had received a median of 3 lines (IQR 4-6); 65% (n=152) of patients were TCR, 71% (n=163) had received autologous stem cell transplant and 7% (n=16) patients had received prior immune effector therapy prior to initiation of Ven-based therapy. The majority (83%, n=190) of the patients harbored a t(11;14); in the patients without t(11;14), a BCL2 expression by IHC was tested in 18 patients and positive in 17 patients. The most common Ven-based combinations included: Dara-Ven-d (19%, n=44), PI-Ven-d (30.2%, n=70), Ven-d (48.3%, n=112), Ven-misc (2.6%, n=6). The overall response rate for the entire cohort was 57% [64% for t(11;14) and 26% for non t(11;14), p&lt;0.0001]. The median PFS for the entire cohort was 9.5 months (95% CI 8.5,13), and the duration of response was 18 months (95% CI 15.2-23.3). The median PFS was 11.8 months (95% CI 9.5-16.7) for patients harboring a t(11;14) compared to 2.9 months (95% CI 1.8, 8.4) for patients without a t(11;14), p&lt;0.0001. Among the non-t(11;14) cohort with BCL2 expression, the median PFS was 1.8 months (95% CI: 1.2-4.2). Among the 190 patients with t(11;14), 18% (34/190) harbored deletion 17p and 32% (60/193) harbored a 1q gain/amplification (referred hereforth as 1q21+) at initiation of Ven-based therapy. In the cohort of patients with t(11;14), the presence of either del17p or 1q21+ (n=85/190) was associated with a significantly inferior PFS [median PFS 8.2 months (95% CI: 5.5,13)] vs. 15.1 months (95% CI: 11.6, 22), p=0.03. At the last follow-up,42 patients had ongoing treatment with ven-based combination. Most common reasons for discontinuation were progression (77% N=140), adverse effect (12%, n=22), patient/provider preference(9%, n=17); 2% (n=4) patients died without progression (3 infection, 1 unclear). The most commonly utilized maximum dose of venetoclax was 400 mg (42%); 15% (n=35) of patients required a dose reduction, and 23% (n=54) received a ramp-up. Tumor lysis syndrome was not noted in any patient. Infectious complications were noted in 23% (n=52). The estimated median OS from initiation of ven-based Rx was 34 months (95%CI 25-47). The estimated median OS for patients without a t(11;14) was 6.2 months (95% CI: 3.3-11.3) compared to 46 months (31.4-54.1), p&lt;0.0001. In the t(11;14) subgroup, the 18-month OS rate was 79% for patients without 1q21+/del17p vs. 50% for patients with a 1q21+/del17p (p=0.002). Conclusion: Venetoclax-based regimens represent an important treatment option for patients harboring a t(11;14). The PFS in patients with BCL2 expression without t(11;14) was poor suggesting lack of efficacy of venetoclax-based regimens for that subgroup. Presence of concurrent del17p and/or 1q21+ with t(11;14) portends an inferior PFS.

Introduction: Given the major treatment advancements in relapsed/refractory multiple myeloma (RRMM) such as bispecific antibodies (BsAbs), understanding patient and healthcare provider (HCP) decision-making perspectives is crucial. This study investigated barriers to adopting resource-intensive novel therapies, unmet needs in access to care, and treatment decision priorities in one of the largest surveys of RRMM patients and HCPs. Methods: This prospective study was conducted from March to June 2024 using 30-minute web-based quantitative surveys fielded in 2269 participants (1301 RRMM patients and 968 HCPs) across 7 countries (US, UK, France, Germany, Italy, Spain, Japan). The survey collected data on pre-defined patient subgroups (line of treatment, ages &lt;45, 46-65, 65+]) and in HCP subgroups (care settings: academic, community [non-Center of Excellence [COE]). Data were analyzed using descriptive statistics and chi-square tests. Results: Two themes that emerged from the findings were: 1) discrepancies in treatment considerations between patients and HCPs, and 2) Familiarity with and considerations around BsAbs among patients Discrepancies in HCP and Patient considerations HCPs and patients prioritized different considerations during treatment decision-making, particularly related to the importance of treatment related adverse events (TRAEs). 3L+ patients equally prioritized disease control and minimizing TRAEs (49% and 49%); HCPs prioritized disease control more often than minimizing TRAEs (59% and 40% for 3L+ patients). Patients considered many TRAEs extremely challenging to manage, whereas HCPs were less likely to do so (patients vs HCPs: bone-related AEs: 64% vs 39%, p&lt;0.001; hypertension: 54% vs 28%, p&lt;0.001; cholesterol: 53% vs 21%, p&lt;0.001; skin-related AEs: 49% vs 30%, p&lt;0.001). Limiting TRAEs was a concern particularly among patients over 65 (52%, p&lt;0.001) and those with comorbidities (52%, p&lt;0.001). Limiting costs and financial challenges (3L+ patients: 33% vs HCPs: 13%, p&lt;0.001) and avoiding compromising the potential to receive treatment options in later lines (3L+ patients: 25% vs HCPs:14%, p&lt;0.001) were other considerations patients prioritized more than HCPs. HCPs prioritized limiting side effects 9% more in 3L settings compared to 2L. Discrepancies in decision-making in 2L setting included a desire to limit treatment-related logistical burden (patients: 35% vs HCP: 17%, p&lt;0.001), limit challenges for care partners (25% vs 13%, p&lt;0.001), and ensure treatment without referral (24% vs 16%, p=0.001). Compared to their older counterparts, younger patients (&lt;45 y v ≥45y) prioritized convenient treatment administration (39% vs 29%, p=0.024) and avoiding referrals to other institutions (32% vs 22%, p&lt;0.001). Perspectives on treatment considerations specific to BsAbs Among 3L+ patients, most have not heard of BsAbs, or have heard but were unfamiliar with the option. A small proportion of 3L+ patients recalled their HCPs suggesting BsAbs as a treatment option (14%) although most patients decided to receive BsAbs treatment when it was offered (71%). Among patients on BsAb treatment, patients most often cited clinical reasons for going on BsAbs (i.e., remission, symptom relief, and likelihood of greater longevity). Among non-clinical reasons, lower time commitment and lower likelihood of negative financial impact compared with other treatments were also common. Notably, 36% of HCPs reported low confidence in identifying RRMM patients eligible for BsAbs. Compared with academic HCPs (32%), more community/non-COE HCPs (42% p=0.018) reported low confidence. Conclusions: HCPs and patients have different priorities during treatment decision-making, particularly regarding the importance of minimizing TRAE and in prioritizing efficacy and managing logistical burdens in later treatment lines. Among novel treatments, BsAbs are not frequently recalled by patients as a treatment option provided by HCPs. HCPs, especially in community settings, are often uncertain about identifying eligible patients for BsAbs, indicating a need for greater educational resources for HCPs. Increasing patient awareness of available treatments, HCP understanding of novel treatments, and fostering dialogue on patient priorities can increase the likelihood of informed, personalized shared decision-making, and optimize evidence-based patient outcomes.

Introduction: Therapeutic advancements for MM have led to improved patient survival, but notable differences in management exist. Novel treatment options are resource-intensive and require adequate patient awareness as well as consideration of patient preferences such that informed decision making is practiced. Despite this, detailed understanding of factors that impact patient decisions regarding healthcare choices, and potentially contribute to variability in healthcare utilization, are under-studied. Additionally, with improved survivorship, the medical, psychosocial, and financial burden of MM management needs to be better understood. Methods: An anonymous, online, 45-question English survey exploring demographics, social determinants of health, selected clinical characteristics, treatment preferences, and survivorship burden was distributed to MM patients within Mayo Clinic and to all International Myeloma Foundation (IMF) support groups. Descriptive statistics were utilized to document participant socio-demographic characteristics, selected treatment history, factors affecting their preferences, and MM survivorship burden. Results: A total of 2239 participants responded to the survey with 54% males, median age 68 years (range 21-95) and median age at MM diagnosis of 67 years. Non-Hispanic Whites (NHW) were the largest (89%) racial-ethnic group. Most participants (71%) had a college degree and 67% had Medicare or Medicaid as primary insurance. MM was diagnosed within 5 years in 58% and 73% were currently on MM treatment at the time of responding to the survey. Majority (76%) had never been on a clinical trial, 59% had received stem cell transplant, 8% had undergone CAR-T therapy and 8% had received Bispecific antibodies as part of their MM management. Majority (64%) preferred oral drugs while 19% preferred injections and 14% infusion therapy.17% had ≥4 healthcare visits per month for MM treatment, 91% used their personal vehicle as the mode of transport for these appointments and the median time to travel to the treatment facility was 30-minutes.Survey participants reported that &gt;10 days of work were missed per year due to MM management among 15% of the patients and 9% of the caregivers, while 15% reported suffering job loss related to MM management. Top factors for treatment decisions were physician recommendations (92%), effectiveness of treatment option (88%), understanding of the treatment(74%), side effects (57%), and family/caregiver input (38%). Psychological challenges and financial strain were reported by 38% and 18% of the respondents, respectively. Increase in healthcare needs since MM diagnosis were reported by 48% and majority reported ongoing symptom burden including fatigue (78%), pain (53%) and neuropathy (60%). Furthermore, of the participants with these symptoms, 67% reported that their fatigue was not relieved by rest, 73% reported their pain to be moderate to severe, and 29% reported their neuropathy to be moderate to severe. Only 42% reported being fully active with the rest reporting varying degrees of functional inabilities. Nearly half (47%) of the participants reported lack of interest or enjoyment in activities they used to like prior to MM diagnosis, however majority (74%) still reported “good” or “excellent” quality of life. A small number of participants reported lack of support from family and friends (4%), lack of support from their healthcare team (3%), difficulty accessing healthcare due to financial hardship (7%) or difficulty accessing healthcare due to job commitments (3%). Conclusions: Decision-making for MM treatment is complex and there are several factors that affect patients behavior. Improved survival in MM is associated with significant survivorship and caregiver burden which can also affect the patient's treatment choices for subsequent therapy. These factors must be addressed systematically to achieve equitable healthcare utilization, shared decision making, and optimal clinical, psychosocial and financial wellbeing of patients with MM.

Introduction: Teclistamab (Tec) is the first approved BCMA x CD3 bispecific antibody for the treatment of triple-class-exposed patients with relapsed/refractory multiple myeloma (RRMM) based on the pivotal MajesTEC-1 study. Tec was associated with high overall response rate (ORR) of 63% in heavily pretreated patients. After a longer follow-up of 30.4 months, CR rate was 46.1%, median duration of response (DOR) was 24 months (95% CI, 17.0 - not estimable), and median progression-free survival (PFS) was 11.4 months (95% CI, 8.8 - 16.4). Herein, we present updated analysis of real-world outcomes and safety with tec in RRMM with extended follow-up of more than 12 months. Methods: This is an international multicenter retrospective study of patients with RRMM treated with tec on-label at 9 academic centers from 5 countries (United States, United Kingdom, Greece, Spain, and Canada) through the International Myeloma Working Group (IMWG) Immunotherapy Committee. Patients with RRMM treated with commercial tec at the respective institutions between May 24, 2022 to January 4, 2024 were included. Median follow-up was 14 months with data collected until July 15, 2024. High-risk cytogenetic abnormalities (HRCA) was defined as 1q+, t(4;14), t(14;16), t(14;20), and/or del(17p). Response was assessed using the IMWG consensus criteria. Patient characteristics were summarized by frequency (percentage) or median (interquartile range [IQR] or range). PFS, overall survival (OS), DOR were evaluated using the Kaplan-Meier method. Results: There were 223 patients included in this analysis with the following characteristics: median age of 67 (range 33-91) with 24% ≥75 years; 45% female; 74% White, 10% Black, 9% Asian, and 7% other/unknown; 86 of 176 (49%) with high risk cytogenetics, including del(17p), t(4;14), t(14;16), t(14;20), and gain/amp 1q; 29.4% (37/126) with known extramedullary disease; 14% with creatinine clearance ≤30 ml/min. Patients received a median of 6 (IQR, 4-8) prior lines of therapy with 52% (107/206) being penta-drug refractory. Among 212 patients with available data, 161 (75.9%) patients would have been ineligible for MajesTEC-1. There were 94 (42%) patients who received prior BCMA-directed therapy (29.8% antibody-drug conjugate [ADC] alone; 45.7% CART alone; 6.3% bispecific antibody alone; 17.0% ADC and CART). Median time from diagnosis to tec initiation was 6.1 (range 0.6-29.2) years. For the 206 response-evaluable patients, ORR was 66%, including 25.2% ≥CR, 33.5% VGPR, and 7.3% PR. ORR for the 90 response-evaluable patients with prior BCMA-directed therapy was 54.5% (21.1% ≥CR, 26.7% VGPR, 6.7% PR). After a median follow-up of 14 (95%CI, 13-14) months, median PFS and OS were 8.8 (95% CI, 5.5-14) and 20 (95% CI, 18-not reached [NR]) months, respectively. 12-month PFS estimate was 46% (95% CI, 40%-54%), and 12-month OS rate was 65% (95% CI, 59%-72%). Median DOR was 17 (95% CI, 17-NR) months with 12-month estimate of 68% (95% CI, 60%-77%). Tec step-up dosing occurred in the outpatient setting for 57 (25.6%) patients. CRS occurred in 119 out of 222 (53.6%) patients with almost all being grade 1-2, except for 1 grade 4 event. ICANS occurred in 18 out of 216 (8.3%) patients (grade 1-2: 5.1%; grade 3-4: 2.8%). Any grade infection occurred in 130 (58.3%) patients; 25.1% of patients had grade ≥3 infection, including 10 patients with grade 5 infection. While receiving teclistamab, 79 (35.4%) patients had ≥2 infections. IVIG was given in 114 out of 164 (69.5%) patients. Conclusion: In this multicenter international real-world analysis of outcomes and safety associated with tec, ORR was high at 66% with 25.2% of patients achieving ≥CR. CR rates may be underestimated due to infrequent bone marrow confirmation in the real-world datasets. Encouragingly, ORR was 54.5% in BCMA exposed RRMM patients, including 21.1% with ≥CR. After a median follow-up of 14 months, heavily pretreated patients including patients with prior BCMA therapy had durable responses with median PFS of 8.8 months and median DOR of 17 months. There were no new safety signals noted in this real-world study. This is the largest real-world study to date of teclistamab with long-term follow-up of more than 12 months. Additional data including more patients, longer follow-up and results from difficult to treat subgroups will be presented at the meeting.

Introduction: The prognosis for CLL/SLL has improved with the advent of novel therapeutic classes, including BTKis. While comparative data for several BTKis have been published, there are limited data on patient preferences in BTKi treatment selection. Understanding and integrating patient perspective in the BTKi treatment selection process is crucial to shared decision-making and attaining optimal treatment outcomes. To understand patients' priorities for different treatment attributes that impact their treatment decisions, a comprehensive quantitative analysis of patient preferences on BTKi treatment attributes was conducted. Methods: A patient survey with a discrete-choice experiment (DCE) design was conducted from March to June 2024 among USA adults (≥18 years) with confirmed diagnosis of CLL/SLL, recruited through online patient panels, physician referrals, and support groups. BTKi treatment attributes were selected based on results of a targeted literature review and clinical inputs. Patients responded to DCE questions on attributes related to efficacy, safety (eg, impacts of diarrhea, headache, atrial fibrillation, and hypertension on quality of life [QoL]), formulation type, and dosing frequency. The impact of adverse events (AEs) on QoL was defined as the extent to which AEs caused interruptions in patients' ability to engage in their usual day-to-day activities. A conditional logistic regression model was used to calculate the relative importance of each attribute, as well as patient willingness to trade off specified BTKi treatment attributes. Results: A total of 200 patients with CLL/SLL completed the survey (median age: 61 years; 78% White; 55% female; 60% commercially insured; 82% suburban/urban residence). Less than half (43%) were diagnosed ≥5 years ago, and 61% received ≥3 lines of therapy. Almost all (89%) patients reported having experienced ≥1 AE from treatment previously, with the most common AEs being fatigue (76%), diarrhea (51%), headache (51%), and nausea and/or vomiting (51%). When considering the importance of efficacy measures, most patients prioritized CLL/SLL treatments that extended life expectancy (93%), followed by those that increased the likelihood of remission or cure (84%) and those that paused the progression of disease (67%). Patients preferred treatments with higher efficacy, less impact of AEs on QoL, and lower dosing frequency (P&lt;.001). The top 3 treatment attributes with the highest relative importance to patients were impact of atrial fibrillation on QoL (24%), progression-free survival (PFS; 19%), and impact of headache on QoL (18%), followed by impact of diarrhea (14%) and hypertension (14%) on QoL, dosing frequency (9%), and formulation type (3%). On average, patients were willing to accept a reduction of 2.6, 1.9, 1.4, and 1.4 years of PFS to receive a treatment with less (none or mild vs significant) impact of atrial fibrillation, headache, diarrhea, and hypertension on QoL, respectively. Patients were willing to accept a reduction of 1.0 year of PFS to receive once-daily vs twice-daily treatment. Conclusions: Findings from this patient preference survey suggested that impact of atrial fibrillation on QoL, PFS, and impact of headache on QoL were the most important attributes of BTKi treatment for patients with CLL/SLL in the USA. Shared decision-making in CLL/SLL treatment selection should include an informed discussion about AEs, as besides efficacy comparisons, patients may prefer treatments with less impact of AEs on their QoL. Future prospective studies evaluating the effects of shared treatment decision-making on treatment adherence and outcomes are needed to better understand their impact on CLL/SLL patient care and inform clinical practice.

Introduction: Oncologists increasingly recognize the need to evaluate the impact of cancer therapies on patients' time, known as “treatment-related time toxicity”, which is measured as the number of days of contact with the healthcare system (Gupta A et al. J Clin Oncol 2022). Current standard-of-care options for patients with TCE RRMM require frequent clinic visits for treatment administration. Reducing treatment-related time toxicity of treatment without compromising efficacy or safety may have an impact on patients' quality of life and influence treatment choice. BCMA-directed bispecific antibodies (BCMA bsAbs) provide a novel treatment option for TCE RRMM, with response-adapted dosing frequency allowing for extended dosing intervals for patients. The frequency of extended dosing intervals varies between BCMA bsAbs according to their prescribing information or pivotal trial protocol. The aim of this analysis was to evaluate the impact of BCMA bsAbs' extended dosing intervals on treatment-related contact (TRC) days corresponding to treatment administration as a component of time toxicity. Methods: An Excel-based longitudinal model was developed to quantify the number of TRC days experienced by patients with TCE RRMM within the healthcare system when receiving treatment with BCMA bsAbs (linvoseltamab, teclistamab, or elranatamab) over 1-2 years. TRC days included all planned treatment administration days. Model inputs were sourced from product labels or pivotal trial protocols for bsAbs, as well as the published literature. To allow for a comparison of total dosing regimens, it was assumed that patients continued receiving treatment throughout the study period with no discontinuation. Dosing intervals for each product during the first 6 months were once weekly (QW), except for linvoseltamab (QW for Weeks 1-14, then once every 2 weeks [Q2W] from Weeks 16-24, per Phase 2 trial protocol). The extended dosing interval for linvoseltamab was Q4W for patients reaching very good partial response or better at or after 24 weeks, and Q2W for both teclistamab patients who maintained a complete response (CR) or better for ≥6 months and for elranatamab patients who reached partial response or better at or after 6 months. Two switching scenarios were considered for teclistamab: an earliest possible switch (at Week 26), and a time-varying switch based on digitized time to CR data from MajesTEC-1 (Usmani SZ et al. ASCO 2023). Results were calculated to evaluate the difference in TRC days between the scenarios with and without extended dosing intervals for each treatment. Results: In the first year of treatment, the total number of TRC days with and without extended dosing intervals was lowest with linvoseltamab. TRC days with linvoseltamab were reduced from 33 to 26 days with extended dosing intervals. Next lowest was elranatamab (53 to 39 days), followed by teclistamab (54 to 41 days for earliest possible switch and 54 to 50 days with time-varying switching). Over 2 years, linvoseltamab had the lowest number of TRC days (59 to 39 days), followed by elranatamab (105 to 65 days) and teclistamab (106 to 67 days for earliest possible switch and 106 to 80 days with time-varying switching). Conclusions: Extended dosing intervals with BCMA bsAbs can substantially reduce time toxicity for patients with RRMM. Linvoseltamab had the lowest number of TRC days among BCMA bsAbs.