What are nurses and patients expressing regarding these daily physical and emotional challenges?

Yeah, that's an excellent question.

And so from my perspective, first as a nurse and as a nurse practitioner, I see firsthand the physical strain that the nurses will go through with the repeated manual push, forcing these thick liquids through a 24-gauge syringe with some of the manual push technologies.

can be a burden.

And then you have this clinic tethering where you're stuck at the bedside.

So the nurse has to sit in the patient's physical space during that three to five minute infusion.

And so that can also be a burden when you are called to duty because somebody is having an injection site or an infusion reaction or need something else.

Dr. Feynman, how does a near elimination of initial infusion reactions reshape nursing monitoring protocols at the clinic?

How does transitioning from manual syringe pushes or IV setups to automated hands-free on-body injection system impact chair turnover, workflow efficiency, and nurse capacity?

I think that there is an alternative workflow that needs to be developed.

So now that this, I'm just thinking of my personal experience, now that this on-body device is approved for use in the United States as of July of 2026, We've had to determine, okay, will this be added to our formulary? So we had to have meetings with our pharmacy and therapeutics committee and decide whether or not this was going to be added to the formulary.

Okay, so now we have two anti-CD38 monoclonal antibodies on formulary.

What does that look like? Now we have to form care pathways to match these new guidelines.

We're going to have to sort out who's dispensing it.

As Dr. Alwadi had mentioned, sometimes the device is in the Pyxis and then the medication is elsewhere.

For both of you, how should clinicians weigh these different modalities when personalizing treatment plans for a diverse patient population?

How significant is needle presentation and gauge size when managing needle phobia and long-term treatment adherence among multiple myeloma patients?

I think it's really important comfort when you're going through these therapies.

So intravenously, you have a peripheral IV, maybe an implanted port-a-catheter, a central line that stays in the system.

But when you have a subcutaneous ability to administer these medications, you don't have to worry about IV access.

You can just draw the appropriate labs to make sure it's safe to get these therapies.

In studies, we have seen that when patients or looking at a thick needle, and then it's then being injected into them, that can add to the anxiety and the needle phobia.

It can also lead to an increased risk of needle sick injuries.

With these sorts of devices now in oncology and diabetes, do the two of you see this as kind of where the direction of a lot of healthcare might be headed in the future? Is this sort of on-body administration prioritizing kind of ease and convenience for both patients and staff?

What are nurses and patients expressing regarding these daily physical and emotional challenges?

Yeah, that's an excellent question.

And so from my perspective, you know, first as a nurse and as a nurse practitioner, I see firsthand the physical strain that the nurses will go through with the repeated manual push, you know, forcing these thick liquids through a 24 gauge syringe with some of the manual push technologies.

can be a burden.

Then you have this clinic tethering where you're stuck at the bedside.

So the nurse has to sit in the patient's physical space during that three to five minute infusion.

And so that can also be a burden when you are called to duty because somebody is having an injection site or an infusion reaction or need something else.

Dr. Feynman, how does a near elimination of initial infusion reactions reshape nursing monitoring protocols at the clinic?

Well, since I think we're talking about advantages and maybe disadvantages of some CAR T, I think this would be a good time to move ahead for best presentation.

Great.

There I am.

I put these slides together myself, so I put a picture of me on there.

Okay.

So many of you have been in oncology for some time, and most of you are probably interested in hematologic cancers, which is why you're here today, and we appreciate you spending your lunch here.

I do want to go over the CAR T-cell manufacturing delivery process.

Thank you so much.

Well, since I think we're talking about advantages and maybe disadvantages of some CAR T, I think this would be a good time to move ahead for best presentation.

Great.

There I am.

I put these slides together myself, so I put a picture of me on there.

Okay.

So many of you have been in oncology for some time, and most of you are probably interested in hematologic cancers, which is why you're here today, and we appreciate you spending your lunch here.

I do want to go over the CAR T-cell manufacturing delivery process.

Thank you so much.

Well, since I think we're talking about advantages and maybe disadvantages of some CAR T, I think this would be a good time to move ahead for best presentation.

Great.

There I am.

I put these slides together myself, so I put a picture of me on there.

Okay.

So many of you have been in oncology for some time, and most of you are probably interested in hematologic cancers, which is why you're here today, and we appreciate you spending your lunch here.

I do want to go over the CAR T-cell manufacturing delivery process.

Thank you so much.

Prophylactic Tosi, yes or no, and are you chasing a magical number of IgG when you're giving IVIG?

Okay, so yes and no.

So no magical number for IgG.

[chuckles] We just give it to everybody.

If we are spacing out the BCMA bispecifics, and they've been on this long term, then we do sometimes, in certain cases, space it out.

Going back to the first question, though, about the prophylactic Tosi, we saw the Opteck Octal data from ASCO this year with eight milligrams per kilogram prophylactic, um, tocilizumab, which decreased the incidence and severity, uh, of patients who had prophylactic tocilizumab.

The other study that I like is the low-dose study from Memorial Sloan Kettering That was published earlier this year with four milligrams of Prophy Tosi, um, and that sh- was shown to decrease the incidence and sever-severity.

Beth, coming back to the partnering of academic center and community settings, how are you doing that in your center, especially f-for that initial referral? Are you administering the induction part of it at Cleveland Clinic and then sending it back to the community colleagues? Or how's that partnership playing out?