Hospital at Home for BCMA-Directed Bispecific Antibodies in Multiple Myeloma: A Multicenter Real-World Feasibility and Safety Study

Purpose BCMA-directed bispecific antibodies (BsAbs) have improved outcomes in relapsed/refractory multiple myeloma (rrMM), but early toxicities often require close hospital monitoring. We evaluated the feasibility and safety of BsAb administration through a Hospital at Home (HaH) model. Patients and Methods We conducted a retrospective multicenter real-world study including consecutive triple-class or penta-refractory rrMM patients treated with teclistamab or elranatamab between July 2022 and January 2024. Outcomes of patients receiving at least one HaH administration were descriptively evaluated alongside those of patients managed exclusively in conventional hospital settings. Safety and survival outcomes were assessed using a 68-day landmark analysis corresponding to the median time to HaH transition. Results Among 201 patients, 46 received HaH administration and 155 were managed exclusively in hospital. Baseline characteristics were broadly comparable, with differences consistent with clinical selection for HaH, notably performance status. After the landmark, no grade ≥3 infection was observed in the HaH group, whereas severe infectious events continued to accumulate in the No HaH group. Rates of post-landmark bacterial, respiratory, opportunistic, and fungal infections were broadly similar across care pathways. Overall survival, progression-free survival, and time to treatment failure did not suggest inferior outcomes in the HaH group. Conclusion In selected rrMM patients, HaH administration of BsAb therapy was feasible and was not associated with inferior survival outcomes. The lower observed rate of severe infections supports further evaluation of this model, while accounting for clinical selection and supportive-care differences. MICROABSTRACT We evaluated Hospital at Home delivery of BCMA-directed bispecific antibodies in 201 patients with relapsed/refractory multiple myeloma. Among 46 patients managed through HaH, post-landmark survival outcomes were not associated with inferior outcomes, and no post-landmark grade ≥3 infection was observed in the HaH group. These findings support further evaluation of HaH models for selected patients receiving complex hematologic therapies.