The purpose of this study is to retrospectively analyze patients receiving bispecific T-cell engagers (BiTEs) at Columbia University-New York Presbyterian Hospital (CU-NYP). We aim to describe the real-world incidence of neurotoxicity associated with these agents along with other descriptive analyses of neurotoxicity associated with BITEs. 

Bispecific T-cell engagers (BiTEs) are an immune therapy indicated for hematologic and solid tumor malignancies. They are monoclonal antibodies engineered to mobilize T-cells to specific antigen targets. While mechanistically distinct from chimeric antigen receptor T-cell (CAR-T) therapy, immune effector cell-associated neurotoxicity (ICANS) has been reported in patients receiving BiTE therapy as well as other forms of neurotoxicity.  

This is a retrospective single-center analysis. Patients who had received one of the following BiTEs: elranatamab, epcoritamab, glofitamab, mosunetuzumab, talquetamab, tarlatamab, teclistamab, at CU-NYP from 01/01/2020 through 03/01/2025 were identified via Epic report. Chart review was then performed and relevant deidentified clinical, diagnostic, and therapeutic information was recorded in a secure database.

A total of 74 patients were identified as having received at least one dose of a BiTE during the time period. The average age was 69 years. 54% percent of the patients were female. 64% of the group had multiple myeloma. 32% of the group were White and 30% were Black. 32% identified as Hispanic ethnicity.  17 cases of possible ICANS were identified. 5 other neurologic toxicities were identified, including headache, dizziness, and cranial nerve palsy. Additional case data pertaining to clinical phenotypes, treatment, and prognosis is currently being analyzed. 

The rate and severity of neurotoxicity from BiTEs in real-world may be higher than reported in clinical trials.  More research is needed to help predict which patients may be more likely to experience neurotoxicity, optimize treatments, and how to better prognosticate on long term neurologic outcomes in patients with neurotoxicity.