Efficacy and Safety of Prophylactic Tocilizumab in Patients with Multiple Myeloma Receiving Bispecific Antibodies: A Systematic Review and Meta-Analysis.

Authors

Angeline Tancherla, Fernando Dharmaraja, Andree Kurniawan

Published in

Oncology research and treatment. Pages 1-20. Jul 22, 2026. Epub Jul 22, 2026.

Abstract

Cytokine release syndrome (CRS) remains a major toxicity associated with bispecific antibody (BsAb) therapy in relapsed/refractory multiple myeloma (RRMM). Prophylactic IL-6 receptor blockade with tocilizumab has emerged as a potential strategy to mitigate CRS; however, its efficacy and safety have not been systematically evaluated.
Databases were searched for studies evaluating prophylactic tocilizumab in patients with RRMM receiving BsAb therapy. Comparative and single-arm studies were included. The primary outcome was CRS incidence. Secondary outcomes included CRS severity, adverse events, hospitalization, and antimyeloma efficacy. Pooled risk ratios (RRs) were calculated using random-effects models due to heterogeneity across studies.
Eight studies encompassing 704 patients were included, comprising five cohorts and three single-arm trials. Meta-analysis of three comparative studies demonstrated that prophylactic tocilizumab is associated with lower all-grade CRS incidence (RR 0.29, 95% CI 0.16-0.53; p < 0.0001), with moderate heterogeneity (I² = 59%). A pooled analysis of two studies evaluating grade ≥2 CRS showed a numerically lower risk with prophylaxis, although this did not reach statistical significance (RR 0.22, 95% CI 0.02-2.57; p = 0.23). CRS events were predominantly low grade, short-lived, and occurred during step-up dosing. ICANS was uncommon, and infection and hematologic toxicity rates were comparable between groups. No signal of reduced overall response rate was observed (RR 1.21, 95% CI 0.91-1.62; p = 0.19).
Prophylactic tocilizumab is associated with lower CRS incidence without compromising efficacy in RRMM patients receiving BsAb therapy. Prospective randomized studies are warranted to confirm these findings and refine prophylactic strategies.

PMID:
42485270
Bibliographic data and abstract were imported from PubMed on 23 Jul 2026.

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