Phase 2 infliximab TNF-α inhibitor prophylaxis with BCMA×CD3/GPRC5D×CD3 bispecifics in R/R myeloma

This Phase 2 supportive-care study tests whether prophylactic infliximab (a TNF-α–neutralizing monoclonal antibody) given 2–4 hours before treatment can reduce cytokine release syndrome (CRS) and related neurotoxicity during standard-of-care teclistamab (a BCMA×CD3 T‑cell–redirecting bispecific antibody, Janssen/Johnson & Johnson) or standard-of-care talquetamab (a GPRC5D×CD3 T‑cell–redirecting bispecific antibody, Janssen/Johnson & Johnson) in relapsed/refractory, measurable multiple myeloma after 5+ prior lines. Patients receive infliximab IV day 1, then proceed with the treating physician’s choice of subcutaneous teclistamab or talquetamab, with serial blood sampling and planned marrow/imaging assessments to link cytokine patterns to toxicity and outcomes. The key angle is whether TNF-α blockade can blunt early inflammatory cascades without dampening bispecific anti-myeloma activity—an increasingly commercial issue as centers push these agents into more outpatient-friendly workflows. In this setting, today’s care is sequential classes (IMiDs, proteasome inhibitors, anti‑CD38 antibodies), then BCMA/GPRC5D T‑cell–redirecting therapy (bispecifics or CAR‑T) plus intensive infection/CRS monitoring; this trial explores a pragmatic add-on to make bispecific delivery safer.