Management of Anemia in Patients Taking Talquetamab

Understanding Anemia with Talquetamab

Talquetamab is a bispecific antibody targeting GPRC5D on myeloma cells and CD3 on T cells, approved for relapsed/refractory multiple myeloma after at least 4 prior therapies, according to the National Comprehensive Cancer Network 2, 3

Evaluate for iron deficiency and other correctable causes of anemia before initiating specific anemia therapy, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
Check iron studies including serum ferritin and transferrin saturation (TSAT) to diagnose absolute iron deficiency (serum ferritin < 100 ng/mL) or functional iron deficiency (TSAT < 20% and serum ferritin > 100 ng/mL), according to the Annals of Oncology and Praxis Medical Insights 1, 4

For patients with confirmed iron deficiency, administer intravenous (IV) iron rather than oral iron, which is less effective during cancer therapy, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
For absolute iron deficiency, administer IV iron according to approved product labels until correction of deficiency, as recommended by the Annals of Oncology 1
For functional iron deficiency, administer 1000 mg iron as single or multiple doses according to available IV iron formulations, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4

If anemia persists after iron replacement or is not related to iron deficiency, consider ESA therapy for patients with hemoglobin < 10 g/dL who are symptomatic or < 8 g/dL even if asymptomatic, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
Recommended ESA dosing includes epoetin alpha, beta, or zeta: approximately 450 IU/week/kg body weight, darbepoetin alpha: 6.75 mg/kg body weight every 3 weeks or 2.25 mg/kg body weight weekly, and epoetin theta: 20,000 IU once weekly, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
Target hemoglobin level should be a stable 12 g/dL without requiring red blood cell transfusions, as recommended by the Annals of Oncology 1

For patients with hemoglobin < 7-8 g/dL or severe anemia-related symptoms, administer red blood cell transfusions without delay, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
Transfuse only the minimum number of RBC units necessary to relieve symptoms or return to a safe hemoglobin range, as recommended by Praxis Medical Insights 4

Consider dose modification of talquetamab only if severe (grade 4) anemia persists despite appropriate management, as recommended by the Journal of the National Comprehensive Cancer Network 2

Monitor hemoglobin levels weekly during initial talquetamab therapy and then every 2-4 weeks once stable, as recommended by Praxis Medical Insights 4
Reassess iron status periodically, especially in patients receiving ongoing ESA therapy, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4

ESA therapy should be used cautiously as it may affect mortality in cancer patients if target hemoglobin levels exceed 12 g/dL, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4
Avoid ESA therapy in patients with active malignancy who are not receiving chemotherapy, as recommended by the Annals of Oncology and Praxis Medical Insights 1, 4