Bispecific and Multispecific Antibodies

The focus of this chapter is on Bispecific antibodies (BsAbs), with a particular focus on multiple myeloma (MM) and lymphoma. The genesis of BsAbs is closely linked to the early understanding of the Y-shaped structure of antibodies in the 1960s, when the interactions between the antigen-binding fragment (Fab) region, which binds to antigens, and the crystallisable fragment (Fc) region, which interacts with the immune system, were first elucidated. BsAbs are engineered antibodies capable of simultaneously binding two distinct antigens or two different epitopes on the same antigen. Compared to monoclonal antibodies (MAbs), BsAbs often exhibit enhanced therapeutic efficacy, particularly in tumor immunotherapy, while also showing promise in the treatment of various other diseases. An important aspect of the delivery of these therapies is the occurrence of specific adverse effects, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which necessitate treatment initiation in centres with expertise in their recognition and management.