Best Practices for Managing Cytokine Release Syndrome and ICANS with Bispecific Antibodies in Follicular Lymphoma

Bispecific antibodies have transformed the treatment landscape for follicular lymphoma, but their use requires vigilant monitoring for immune-related toxicities, particularly cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). Best practices involve early identification of symptoms, graded according to established criteria, and rapid intervention to mitigate severity. CRS management typically includes supportive care, corticosteroids, and targeted cytokine blockade when indicated, while ICANS may require neurological assessments, seizure prophylaxis, and corticosteroid therapy. Pre-infusion risk stratification, patient education, and structured monitoring protocols are critical to ensure timely recognition and intervention. Multidisciplinary coordination among physicians, nurses, and pharmacists is essential for safe administration and ongoing assessment. By implementing standardized monitoring and management strategies, clinicians can maximize the therapeutic benefits of bispecific antibodies while minimizing treatment-related morbidity and ensuring patient safety throughout the course of therapy.