Multiple myeloma (MM) is a disabling hematologic malignancy requiring continuous therapeutic innovation and timely intervention to improve patient outcomes. Despite improvements in upfront therapies, patients with MM may suffer from relapsed or refractory disease, necessitating novel treatment approaches. Bispecific antibodies (BsAbs) represent a breakthrough therapy for patients with relapsed/refractory multiple myeloma. Their adoption within large, federally managed health systems like the VA, however, presents unique challenges including clinical familiarity, multidisciplinary coordination, and safety infrastructure. Additional barriers to veteran care may include comorbid disease, lack of caregiver support, or transportation burden.

To address this unmet need, this initiative aimed to increase institutional readiness and clinical capacity for BsAb use within VISN 20, leveraging the VA Puget Sound Health Care System (VAPSHCS) as a specialty care hub, through a structured educational series and development of standardized clinical protocols. A faculty-led Project ECHO series was delivered across 8 sessions over 12 months to educate VISN 20 providers on the mechanism of action, safety, efficacy, and use of BsAbs. Specific barriers to BsAb care within the VA system were identified and veteran-centric solutions were examined. In parallel, VAPSHCS convened a multidisciplinary expert panel to create and implement two clinical protocols: one for the management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), and a second aligning with the VA national formulary guidance for BsAb eligibility and dosing. All eight ECHO sessions were completed with multidisciplinary provider engagement [Pharmacists (67%), Physicians (25%), and Allied Health Professional (8%). 100% of the multidisciplinary providers reported that engagement in the ECHO sessions would help them overcome barriers in practice and committed to making practice changes that would impact patient care.

The newly developed VA protocols have been successfully implemented at VAPSHCS. The initiative has since informed broader efforts to scale these protocols across VISN 20, expanding access to care to more veterans. This education and protocol integration model is a replicable approach that can be used by other VA facilities to safely and efficiently implement BsAb therapy within their existing infrastructure and foster hub and spoke care between specialized and under-resourced VA facilities.

This material is the result of work supported with resources and the use of facilities at the VA Puget Sound Health Care System, Seattle WA.

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Governmen

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2025
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