Education, Infection Vigilance Define Outpatient Bispecific Care

As bispecific antibodies and cellular therapies move into the outpatient setting and earlier lines of therapy, repeated patient education and vigilance for atypical infections will define the role of oncology nurses and advanced practice providers (APPs) in malignant hematology, according to Kate Kennedy, MSN, APRN, ACNP-BC, AOCNP.

Kennedy, outpatient malignant hematology APP team lead at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, leads an APP-led outpatient bispecific antibody clinic that received a 2026 Association of Cancer Care Centers Innovator Award.¹ Asked how the role of nurses and APPs will change in the next few years, she pointed first to education.

Why will patient education matter even more?

"Education is huge," Kennedy said in an interview with Oncology Nursing News. "I can't say enough good things about the education visits that we do. And I would like to expand that to all of the drugs that we do for education visits, but education, education, education."

At Vanderbilt-Ingram, patients starting a bispecific antibody attend a 1-hour education visit with an APP before the first dose, with a caregiver present. The visit covers what cytokine release syndrome (CRS) and neurotoxicity look like, whom to call during the day and after hours, and backup plans. Kennedy said that teaching should be reinforced "over and over and over again so that patients understand what they're looking for, what to do when it happens, the contingency plan."

Those plans account for the unexpected. "Somebody drops a phone, can't get in touch," she said. "They can't get through. The lines are down. There's a big ice storm, you know, crazy things."

How do risks change over the course of bispecific therapy?

Education also prepares patients for how risks shift over time. "In the beginning we worry about CRS and ICANS and that kind of stuff, but as we go through it we worry more about, especially with the myeloma bispecifics, we worry more about infection risk," Kennedy said.

In her practice, patients start intravenous immunoglobulin (IVIG) when they start the drug and continue it monthly, "whether or not your IgG is greater than 400," she said. A level high enough to prompt a discussion about stopping IVIG "rarely is" seen with these drugs, she added. She also noted that her team, with a physician and pharmacist colleague, recently published work on decreasing the frequency of teclistamab (Tecvayli) dosing to every 3 months in patients who maintain deep remissions.

In prior coverage, Beth Faiman, PhD, MSN, APN-BC, BMTCN, AOCN, FAAN, FAPO, explained that BCMA-directed bispecific antibodies can compromise humoral immunity and stressed the importance of prophylactic strategies, including antiviral prophylaxis even when dosing intervals are extended.² Samantha Shenoy, MSN, NP, of UCSF, noted after the second-line approval of teclistamab plus daratumumab and hyaluronidase-fihj (Darzalex Faspro) that IVIG and prophylaxis should continue even after patients stop the drug.³

What will infection vigilance look like as patients stay on treatment longer?

Kennedy expects more unusual presentations as patients remain on these therapies. "As we see more of these patients on it longer term, we're probably gonna see maybe some more of these atypical or stranger maybe infections," she said.

That requires clinicians to keep a broad differential when symptoms are vague. "We don't think it's CRS because it's so many cycles in," she said. "So like what else could it be, thinking about remembering that these other things could possibly also be going on."

What are the key takeaways for oncology nurses?

• Build dedicated education visits for complex therapies and include caregivers.
• Reinforce teaching at every visit, not only before the first dose.
• Plan for communication failures, such as lost phones, downed lines, and severe weather.
• Shift counseling from CRS and neurotoxicity early on to infection prevention later in treatment.
• Consider atypical infections when patients many cycles into therapy present with vague symptoms.

References

1. 2026 ACCC Innovator Award winners: Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center. Association of Cancer Care Centers. Accessed October 28, 2026. https://www.accc-cancer.org/about-accc/awards/accc-innovator-awards/2026-winners/vanderbilt-university-medical-center-vanderbilt-ingram-cancer-center
2. Faiman B. Managing infection risk with bispecific antibodies in myeloma. Oncology Nursing News. September 1, 2025. Accessed October 28, 2026. https://www.oncnursingnews.com/view/managing-infection-risk-with-bispecific-antibodies-in-myeloma
3. Hoyt B. Nursing considerations for teclistamab/SC daratumumab's approval in second-line MM. Oncology Nursing News. March 10, 2026. Accessed October 28, 2026. https://www.oncnursingnews.com/view/nursing-considerations-for-teclistamab-sc-daratumumab-s-approval-in-second-line-mm