EMMBRAce Project

Helping you to deliver bispecific antibody therapy to patients in the UK.

With exciting NICE approvals of Teclistamab and Eranatamab, we want to ensure patients with Myeloma across the UK have fair access to these treatments. However, there are challenges to delivery. We are a group of NHS haematology healthcare professionals across the UK that are working to support hospitals to deliver this new therapy to patients.

This website contains resources to support the development of services to provide bispecific antibodies to patients with Multiple Myeloma. This project is ongoing and resources will be added as they are developed. We aim to develop and provide:

Guidance on service development
Templates for referrals
Educational resources

Updates

Improved Access to Immunoglobulin (IG) for Multiple Myeloma Patients receiving Bispecific Antibodies
This month, the NHS updated its clinical commissioning policy in England for immunoglobulin (IG) use, making it easier and quicker for patients with multiple myeloma receiving bispecific antibodies to access IG. This is a welcome change that will help reduce infection risks for this vulnerable group and brings us in line with many other countries and international guidelines.
Previously, under the Secondary Antibody Deficiency – Long-Term Use category, patients needed to meet all the following criteria:
·      Underlying cause of Hypogammaglobulinaemia cannot be reversed, or reversal is contraindicated, OR
·      Hypogammaglobulinaemia associated with drugs including emerging bispecifics
AND
a.        Recurrent or severe bacterial infection despite continuous oral antibiotic therapy for 6 months
b.        IgG <4g/L excluding paraprotein
c.        Documented failure of serum antibody response to unconjugated pneumococcal or other polysaccharide vaccine challenge (may be omitted if IgG <3g/L)
Following a review, NHS commissioners in England now acknowledges that not all of these criteria must be met. The policy has been expanded to allow IG use at the start of bispecific antibody treatment for patients with myeloma as well as B-cell lymphoma. Acknowledging that many of these patients already have low serum IgG levels due to prior chemo-immunotherapy, including CD20- and CD38-targeting agents. Now, prophylactic IVIG can be considered for those with serum IgG < 4 g/L at the time of bispecific antibody initiation.
As part of the EMMBRAce Bispecific Antibody Implementation Group, we made the case to the Immunoglobulin Expert Working Group that prophylactic Ig was essential to reduce severe infections in patients receiving these treatments.  We submitted evidence from clinical trials as well as real world data showing the impact of this therapy on reducing infection risk.  This is in accordance with the International Myeloma Working Group Bispecific Guidelines.
This update represents an important step in improving infection prevention and access to supportive care for myeloma patients.[HT6] [DB7]   We are continuing our work to improve the use of bispecific antibodies in myeloma patients and will now be focusing on the impact of the increased use of IVIG on hospital capacity, improving access to subcutaneous Ig and writing guidelines in collaboration with Immunology experts to ensure Ig is used optimally.
Slides submitted can be viewed here

nhse_immunoglobulin_proposal.pdf

Full policy can be seen here.

About us

This project is being led and overseen by a steering group involving a multidisciplinary team of NHS doctors, nurses and pharmacists from across the UK alongside charity and industry partners.