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Teclistamab

  • Bispecific T-cell engagersBispecific T-cell engagers
  • High alertAn error with this medicine can cause serious harm: double checks and protocols are used.

Bispecific antibody that links CD3 on T cells to BCMA on myeloma cells; for relapsed multiple myeloma. Boxed risks: cytokine release syndrome and neurotoxicity.

Updated

Also called: teclistamab-cqyv, BCMA × CD3 bispecific antibody

Quick facts

Group
Bispecific T-cell engagers
Target
BCMA (B-cell maturation antigen, TNFRSF17) on myeloma cells, and CD3 on T cells
Key effects
Injection-site reactions · Fever · Joint
Monitor
Temperature · Neurological checks · Liver tests
ATC
L01FX24

No doses: the clinician sets them by the current guideline.

Mechanism of action

The cryo-EM structure shows BCMA held by the BCMA-binding Fab arm of teclistamab (with a second Fab used to stabilise the complex); the CD3 arm is not in the structure.

Target in 3D: BCMA (B-cell maturation antigen, TNFRSF17) on myeloma cells, and CD3 on T cells. PDB structure 12ER (RCSB PDB, public domain). View the structure at RCSB PDB

Teclistamab is a bispecific T-cell engager: one arm binds CD3 on the patient's T cells and the other binds BCMA, a receptor expressed on myeloma plasma cells. Bringing the two cells together activates the T cell without MHC presentation; it releases cytotoxic granules and kills the myeloma cell, and the activation releases cytokines.

  1. One arm binds BCMA on the myeloma cell
  2. The other arm binds CD3 on a T cell
  3. The T cell is activated and kills the plasma cell
  4. Cytokines are released (CRS risk, worst early)

Indications

  • Relapsed or refractory multiple myeloma after several prior lines including an immunomodulatory drug, a proteasome inhibitor and an anti-CD38 antibody; also with daratumumab after fewer prior lines. Multiple myeloma →

Adverse effects

Common

  • Injection-site reactions
  • Fever, fatigue
  • Joint, back or bone pain
  • Nausea, diarrhoea, constipation
  • Swelling of the legs
  • Low blood counts

Contraindications

  • Known allergy to the drug
  • Active serious infection is treated before starting

Key interactions

Other prescription and non-prescription medicines, vitamins and herbal products
The full list is reviewed before starting, because doses of other drugs may need adjusting.

What is monitored

  • Temperature, blood pressure and oxygen saturation after each step-up dose
  • Neurological checks (orientation, writing, speech)
  • Complete blood count and signs of infection
  • Liver tests
  • History of shingles before starting

Administration and safety

  • Subcutaneous injection by a health professional; the step-up doses are usually given in hospital with monitoring afterwards.
  • Premedication is given before the step-up doses as ordered.
  • Available only through a FDA risk management programme (REMS) with certified prescribers and centres.
  • Check the drug name and the dose step carefully: step-up and treatment doses differ.

Pregnancy and breastfeeding

May harm the fetus; a pregnancy test is done before starting and effective contraception is used during and after treatment.

Nursing care

  • Check vital signs often after the first doses and report fever, hypotension or hypoxia.
  • Do neurological checks and report confusion, drowsiness or trouble writing.
  • Watch for infection; report fever, cough or a painful rash.
  • Teaching: do not drive or operate machinery for 48 hours after each step-up dose or while having neurological symptoms; use effective contraception.

Pharmacokinetics

Absorption
Subcutaneous injection; first step-up doses, then regular treatment doses.
Elimination
Broken down like other antibodies.

Test yourself

Think of the answer, then tap the question to see it.

Which two antigens does teclistamab bind?

BCMA on myeloma cells and CD3 on T cells.

Why are teclistamab's first doses given as step-up doses in hospital?

Because cytokine release syndrome and neurotoxicity are most frequent after the first doses.

For which cancer is teclistamab used?

Relapsed or refractory multiple myeloma.

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More Pharmacology questions →

Connections

← Back to the class: Bispecific T-cell engagers

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Teclistamab-cqyv - NCI (National Cancer Institute, 2026); Teclistamab-cqyv Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.