ORAL COMPLICATIONS AND DENTAL MANAGEMENT IN PATIENTS RECEIVING CAR T-CELL THERAPY AND T-CELL–ENGAGING BISPECIFIC ANTIBODIES
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6548Keywords:
CAR T-cell Therapy, Bispecific Antibodies, Oral Complications, Dental Management, Talquetamab, Dysgeusia, Xerostomia, InfectionAbstract
Background: CAR T-cell therapy and T-cell–engaging bispecific antibodies have transformed the treatment of relapsed or refractory hematological malignancies, but their oral and dental consequences remain incompletely characterized.
Objective: To synthesize open-access evidence on oral complications associated with CAR T-cell therapy and bispecific antibodies and to propose a practical dental-management algorithm.
Methods: A structured narrative search of open-access literature published from 2015 through July 28, 2026 was conducted, with emphasis on PubMed/MEDLINE, PubMed Central, open-access publisher platforms, and reference-list screening. Evidence was synthesized according to treatment mechanism, molecular target, oral manifestation, and phase of care.
Results: CAR T-cell therapy and BCMA-targeting bispecific antibodies are primarily relevant to dental care because of cytopenias, hypogammaglobulinemia, impaired immune recovery, and infection risk. GPRC5D-targeting treatment, particularly talquetamab, is additionally associated with dysgeusia, oral dryness, swallowing difficulties, mucosal changes, dietary restriction, and weight loss. Direct oral evidence after CAR T-cell therapy remains sparse.
Conclusions: Dental care should be individualized according to treatment phase, molecular target, immune status, blood counts, infection risk, and functional effects of oral toxicity. The proposed algorithm is expert-informed and requires prospective validation.
References
Abdalla-Aslan, R., Bonomo, P., Keefe, D., Blijlevens, N., Cao, K., Cheung, Y. T., Fregnani, E. R., Miller, R., Raber-Durlacher, J., Epstein, J., van Sebille, Y., Kauark-Fontes, E., Kandwal, A., McCurdy-Franks, E., Finkelstein, J., McCarvell, V., Zadik, Y., Ottaviani, G., Mendes, R. A., … Bossi, P. (2024). Guidance on mucositis assessment from the MASCC mucositis study group and ISOO: An international delphi study. eClinicalMedicine, 73, Article 102675. https://doi.org/10.1016/j.eclinm.2024.102675
Agholme, M. B., Dahllöf, G., Karlsson Törlén, J., Majorana, A., Brennan, M. T., von Bültzingslöwen, I., Tan, P. L., Hu, S., Sim, Y. F., & Hong, C. (2023). Incidence, severity, and temporal development of oral complications in pediatric allogeneic hematopoietic stem cell transplant patients: A multicenter study. Supportive Care in Cancer, 31, Article 702. https://doi.org/10.1007/s00520-023-08151-1
Alves, F. A., Perez Perez, A., Jaguar, G. C., Schmidt Filho, J., Kim, M. K., & Villa, A. (2026). On-target, off-tumor oral toxicities of talquetamab in heavily pretreated multiple myeloma. Supportive Care in Cancer, 34, Article 347. https://doi.org/10.1007/s00520-026-10583-4
Arya, S., & Shahid, Z. (2024). Overview of infectious complications among CAR t-cell therapy recipients. Frontiers in Oncology, 14, Article 1398078. https://doi.org/10.3389/fonc.2024.1398078
Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—A scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4, Article 5. https://doi.org/10.1186/s41073-019-0064-8
Bishop, M. R. (2024). Late complications and long-term care of adult CAR t-cell patients. Hematology: American Society of Hematology Education Program, 2024(1), 109–115. https://doi.org/10.1182/hematology.2024000534
Cappell, K. M., & Kochenderfer, J. N. (2023). Long-term outcomes following CAR t cell therapy: What we know so far. Nature Reviews Clinical Oncology, 20(6), 359–371. https://doi.org/10.1038/s41571-023-00754-1
Correa, M. E. P., Granzotto, F. C. N., Innocentini, L. M. A. R., Reis, T. C., de Lima, E. M., Varanda, R. F., Santos, P. S. S., Soares Junior, L. A. V., Bezinelli, L. M., de Paula Eduardo, F., Melo, W. R., Antunes, H. S., & De Macedo, L. D. (2023). Brazilian dental consensus on dental management in hematopoietic stem cell transplantation—Part i—pre-hsct. Hematology, Transfusion and Cell Therapy, 45(3), 358–367. https://doi.org/10.1016/j.htct.2023.04.001
Dean, D., Lee, S. J., Cutler, C., Gooley, T. A., Hujoel, P., Oh, U. Y., Bennett-Johnson, L., Hagstrom, M. K., Rothen, M., Lloid, M., Sroussi, H., & Treister, N. (2024). Dental evaluation and clearance prior to allogeneic hematopoietic cell transplantation. Oral Diseases, 30(4), 2635–2644. https://doi.org/10.1111/odi.14717
de Paula Eduardo, F., Menti, L. D., Ferreira, M. H., de Carvalho, D. L. C., Novaes, C. de P., Martins, B. H. da S., Kerbauy, L. N., Hamerschlak, N., & Bezinelli, L. M. (2026). Oral manifestations and dental management in patients undergoing CAR-T cell therapy: A retrospective observational study. Supportive Care in Cancer, 34, Article 621. https://doi.org/10.1007/s00520-026-10824-6
Devasia, A. J., Chari, A., & Lancman, G. (2024). Bispecific antibodies in the treatment of multiple myeloma. Blood Cancer Journal, 14, Article 158. https://doi.org/10.1038/s41408-024-01139-y
Elad, S., Raber-Durlacher, J. E., Brennan, M. T., Saunders, D. P., Mank, A. P., Zadik, Y., Quinn, B., Epstein, J. B., Blijlevens, N. M. A., Waltimo, T., Passweg, J. R., Correa, M. E. P., Dahllöf, G., Garming-Legert, K. U. E., Logan, R. M., Potting, C. M. J., Shapira, M. Y., Soga, Y., Stringer, J., … Jensen, S. B. (2015). Basic oral care for hematology–oncology patients and hematopoietic stem cell transplantation recipients: A position paper from the joint task force of MASCC/ISOO and EBMT. Supportive Care in Cancer, 23(1), 223–236. https://doi.org/10.1007/s00520-014-2378-x
Elad, S., Cheng, K. K. F., Lalla, R. V., Yarom, N., Hong, C., Logan, R. M., Bowen, J., Gibson, R., Saunders, D. P., Zadik, Y., Ariyawardana, A., Correa, M. E. P., Ranna, V., Bossi, P., & Mucositis Guidelines Leadership Group of MASCC/ISOO (2020). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 126(19), 4423–4431. https://doi.org/10.1002/cncr.33100
Epperly, R., Giordani, V. M., Mikkilineni, L., & Shah, N. N. (2023). Early and late toxicities of chimeric antigen receptor t-cells. Hematology/Oncology Clinics of North America, 37(6), 1169–1188. https://doi.org/10.1016/j.hoc.2023.05.010
Fleischer, A., Roll, M., Frenking, J. H., Panther, F., Gelbrich, G., Strunz, P.-P., Riedhammer, C., Peter, J., Mersi, J., Waldschmidt, J., Kortüm, M., Einsele, H., Raab, M.-S., Maatouk, I., & Rasche, L. (2025). Talquetamab-related dysgeusia in multiple myeloma compared to bcma-targeted bispecifics and high-dose melphalan. Cancer Medicine, 14(23), Article e71401. https://doi.org/10.1002/cam4.71401
Fregnani, E. R., Epstein, J. B., Blijlevens, N. M. A., Yarom, N., Villa, A., Raber-Durlacher, J. E., Gardner, P. J., Shem, D., Beaumont, S., Bossi, P., & Elad, S. (2025). MASCC/ISOO clinical practice statement: Management of oral complications of immunotherapy. Supportive Care in Cancer, 33, Article 851. https://doi.org/10.1007/s00520-025-09806-x
Frerichs, K. A., Verkleij, C. P. M., Mateos, M. V., Martin, T. G., Rodriguez, C., Nooka, A. K., Banerjee, A., Chastain, K., Perales-Puchalt, A., Stephenson, T., Uhlar, C., Kobos, R., van der Holt, B., Kruyswijk, S., Kuipers, M. T., Groen, K., Vishwamitra, D., Skerget, S., Cortes-Selva, D., … van de Donk, N. W. C. J. (2024). Teclistamab impairs humoral immunity in patients with heavily pretreated myeloma: Importance of immunoglobulin supplementation. Blood Advances, 8(1), 194–206. https://doi.org/10.1182/bloodadvances.2023011658
Hong, C., Epstein, J. B., Jensen, S. B., Gueiros, L. A., van Leeuwen, S. J. M., Kandwal, A., Vissink, A., & Elad, S. (2024a). MASCC/ISOO clinical practice statement: Clinical assessment of salivary gland hypofunction and xerostomia in cancer patients. Supportive Care in Cancer, 32, Article 551. https://doi.org/10.1007/s00520-024-08691-0
Hong, C., Jensen, S. B., Vissink, A., Bonomo, P., Santos-Silva, A. R., Gueiros, L. A., Epstein, J. B., & Elad, S. (2024b). MASCC/ISOO clinical practice statement: Management of salivary gland hypofunction and xerostomia in cancer patients. Supportive Care in Cancer, 32, Article 548. https://doi.org/10.1007/s00520-024-08688-9
Jain, T., Olson, T. S., & Locke, F. L. (2023). How i treat cytopenias after CAR t-cell therapy. Blood, 141(20), 2460–2469. https://doi.org/10.1182/blood.2022017415
Labanca, C., Martino, E. A., Vigna, E., Bruzzese, A., Mendicino, F., Lucia, E., Olivito, V., Puccio, N., Neri, A., Morabito, F., & Gentile, M. (2025). Talquetamab in multiple myeloma: Efficacy, safety, and future directions. European Journal of Haematology, 114(3), 386–399. https://doi.org/10.1111/ejh.14353
Laheij, A. M. G. A., & van de Donk, N. W. C. J. (2024). Characterization of dysgeusia and xerostomia in patients with multiple myeloma treated with the t-cell redirecting GPRC5D bispecific antibody talquetamab. Supportive Care in Cancer, 32, Article 20. https://doi.org/10.1007/s00520-023-08233-0
Lesokhin, A. M., Tomasson, M. H., Arnulf, B., Bahlis, N. J., Prince, H. M., Niesvizky, R., Rodríguez-Otero, P., Martinez-Lopez, J., Koehne, G., Touzeau, C., Jethava, Y., Quach, H., Depaus, J., Yokoyama, H., Gabayan, A. E., Stevens, D. A., Nooka, A. K., Manier, S., Raje, N., … Mohty, M. (2023). Elranatamab in relapsed or refractory multiple myeloma: Phase 2 magnetismm-3 trial results. Nature Medicine, 29(9), 2259–2267. https://doi.org/10.1038/s41591-023-02528-9
Los-Arcos, I., Iacoboni, G., Aguilar-Guisado, M., Alsina-Manrique, L., Díaz de Heredia, C., Fortuny-Guasch, C., García-Cadenas, I., García-Vidal, C., González-Vicent, M., Hernani, R., Kwon, M., Machado, M., Martínez-Gómez, X., Ortiz Maldonado, V., Pinto Pla, C., Piñana, J. L., Pomar, V., Reguera-Ortega, J. L., Salavert, M., … Ruiz-Camps, I. (2021). Recommendations for screening, monitoring, prevention, and prophylaxis of infections in adult and pediatric patients receiving CAR t-cell therapy: A position paper. Infection, 49(2), 215–231. https://doi.org/10.1007/s15010-020-01521-5
Mitra, A., Barua, A., Huang, L., Ganguly, S., Feng, Q., & He, B. (2023). From bench to bedside: The history and progress of CAR t cell therapy. Frontiers in Immunology, 14, Article 1188049. https://doi.org/10.3389/fimmu.2023.1188049
Mohan, M., Chakraborty, R., Bal, S., Nellore, A., Baljevic, M., D’Souza, A., Pappas, P. G., Berdeja, J. G., Callander, N., & Costa, L. J. (2023). Recommendations on prevention of infections during chimeric antigen receptor t-cell and bispecific antibody therapy in multiple myeloma. British Journal of Haematology, 203(5), 736–746. https://doi.org/10.1111/bjh.18909
Naqvi, S. A. H., Shrestha, A., Alzubi, M., Alrawabdeh, J., Thanendrarajan, S., Zangari, M., van Rhee, F., Schinke, C., & Al Hadidi, S. (2024). Weight loss and dysgeusia in relapsed/refractory multiple myeloma patients treated with talquetamab. eJHaem, 5(4), 789–792. https://doi.org/10.1002/jha2.971
Nooka, A. K., Rodriguez, C., Mateos, M. V., Manier, S., Chastain, K., Banerjee, A., Kobos, R., Qi, K., Verona, R., Doyle, M., Martin, T. G., & van de Donk, N. W. C. J. (2024). Incidence, timing, and management of infections in patients receiving teclistamab for the treatment of relapsed/refractory multiple myeloma in the majestec-1 study. Cancer, 130(6), 886–900. https://doi.org/10.1002/cncr.35107
Parrondo, R. D., Ailawadhi, S., & Cerchione, C. (2024). Bispecific antibodies for the treatment of relapsed/refractory multiple myeloma: Updates and future perspectives. Frontiers in Oncology, 14, Article 1394048. https://doi.org/10.3389/fonc.2024.1394048
Raber-Durlacher, J. E., Zadik, Y., Treister, N. S., Stempler, N., Bruno, J. S., Epstein, J. B., & Elad, S. (2024). MASCC/ISOO clinical practice statement: Current understanding on controversies in basic oral care in hemato-oncology and hematopoietic cell transplantation. Supportive Care in Cancer, 32, Article 550. https://doi.org/10.1007/s00520-024-08690-1
Raje, N., Anderson, K., Einsele, H., Efebera, Y., Gay, F., Hammond, S. P., Lesokhin, A. M., Lonial, S., Ludwig, H., Moreau, P., Patel, K., Ramasamy, K., & Mateos, M.-V. (2023). Monitoring, prophylaxis, and treatment of infections in patients with MM receiving bispecific antibody therapy: Consensus recommendations from an expert panel. Blood Cancer Journal, 13, Article 116. https://doi.org/10.1038/s41408-023-00879-7
Rodriguez-Otero, P., van de Donk, N. W. C. J., Pillarisetti, K., Cornax, I., Vishwamitra, D., Gray, K., Hilder, B., Tolbert, J., Renaud, T., Masterson, T., Heuck, C., Kane, C., Verona, R., Moreau, P., Bahlis, N. J., & Chari, A. (2024). GPRC5D as a novel target for the treatment of multiple myeloma: A narrative review. Blood Cancer Journal, 14, Article 24. https://doi.org/10.1038/s41408-023-00966-9
Schinke, C., Touzeau, C., Oriol, A., Mateos, M.-V., Stevens, D., Rasche, L., Qin, X., Kato, K., Bathija, S., Katz, E. G., Gries, K. S., Campagna, M., Masterson, T., Hilder, B. W., Tolbert, J., Renaud, T., Heuck, C., Tomlinson, C., Moreau, P., … Chari, A. (2025). Talquetamab improves patient-reported symptoms and health-related quality of life in relapsed or refractory multiple myeloma: Results from the phase 1/2 monumental-1 study. Cancer, 131(14), Article e35927. https://doi.org/10.1002/cncr.35927
Sim, B. Z., Longhitano, A., Er, J., Harrison, S. J., Slavin, M. A., & Teh, B. W. (2023). Infectious complications of bispecific antibody therapy in patients with multiple myeloma. Blood Cancer Journal, 13, Article 34. https://doi.org/10.1038/s41408-023-00808-8
Skallsjö, K., von Bültzingslöwen, I., Hasséus, B., Johansson, J.-E., Öhman, J., Raber-Durlacher, J. E., Huysmans, M.-C. D. N. J. M., Laheij, A. M. G. A., van Leeuwen, S. J. M., Hovan, A. J., Legert, K. G., Nguyen, H. M., Turk, P. J., Rozema, F. R., Blijlevens, N. M. A., & Brennan, M. T. (2023). Oral health in patients scheduled for hematopoietic stem cell transplantation in the orastem study. PLOS ONE, 18(5), Article e0285615. https://doi.org/10.1371/journal.pone.0285615
Sutherland, N. M., Zhou, B., Zhang, L., Ong, M.-S., Hong, J. S., Pak, A., Liu, K. J., Frigault, M. J., Maus, M. V., Hill, J. A., Reynolds, K., Walter, J. E., Camargo, C. A., Jr., & Barmettler, S. (2025). Association of cd19+-targeted chimeric antigen receptor t-cell therapy with hypogammaglobulinemia, infection, and mortality. Journal of Allergy and Clinical Immunology, 155(2), 605–615. https://doi.org/10.1016/j.jaci.2024.10.021
Tabbara, N., Dioverti-Prono, M. V., & Jain, T. (2024). Mitigating and managing infection risk in adults treated with CAR t-cell therapy. Hematology: American Society of Hematology Education Program, 2024(1), 116–125. https://doi.org/10.1182/hematology.2024000535
Tan, C. R., Asoori, S., Huang, C.-Y., Brunaldi, L., Popat, R., Kastritis, E., Martinez-Lopez, J., Bansal, R., Silva Corraes, A. D. M., Chhabra, S., Parrondo, R., Ailawadhi, S., Fotiou, D., Dimopoulos, M. A., Yong, K., Mactier, C., Lau, C., Corona, M., Sáez Marin, A. J., … Lin, Y. (2025). Real-world evaluation of teclistamab for the treatment of relapsed/refractory multiple myeloma: An international myeloma working group study. Blood Cancer Journal, 15, Article 53. https://doi.org/10.1038/s41408-025-01259-z
van Gennip, L. L. A., Bulthuis, M. S., Blijlevens, N. M. A., Huysmans, M.-C. D. N. J. M., van Leeuwen, S. J. M., & Thomas, R. Z. (2023). Caries, periodontitis and tooth loss after haematopoietic stem cell transplantation: A systematic review. Oral Diseases, 29(7), 2578–2591. https://doi.org/10.1111/odi.14358
van Leeuwen, S. J. M., Proctor, G. B., Laheij, A. M. G. A., Potting, C. M. J., Smits, O., Bronkhorst, E. M., Hazenberg, M. D., Haverman, T. M., Brennan, M. T., von Bültzingslöwen, I., Raber-Durlacher, J. E., Huysmans, M.-C. D. N. J. M., Rozema, F. R., & Blijlevens, N. M. A. (2021). Significant salivary changes in relation to oral mucositis following autologous hematopoietic stem cell transplantation. Bone Marrow Transplantation, 56(6), 1381–1390. https://doi.org/10.1038/s41409-020-01185-7
Wang, X. S., & Srour, S. A. (2024). Patient-reported outcomes after CAR t-cell therapy in patients with hematological malignancies. Hematology: American Society of Hematology Education Program, 2024(1), 102–108. https://doi.org/10.1182/hematology.2024000536
Wudhikarn, K., Palomba, M. L., Pennisi, M., Garcia-Recio, M., Flynn, J. R., Devlin, S. M., Afuye, A., Silverberg, M. L., Maloy, M. A., Shah, G. L., Scordo, M., Dahi, P. B., Sauter, C. S., Batlevi, C. L., Santomasso, B. D., Mead, E., Seo, S. K., & Perales, M.-A. (2020). Infection during the first year in patients treated with CD19 CAR t cells for diffuse large b cell lymphoma. Blood Cancer Journal, 10, Article 79. https://doi.org/10.1038/s41408-020-00346-7
Wudhikarn, K., & Perales, M.-A. (2022). Infectious complications, immune reconstitution, and infection prophylaxis after CD19 chimeric antigen receptor t-cell therapy. Bone Marrow Transplantation, 57(10), 1477–1488. https://doi.org/10.1038/s41409-022-01756-w
Yang, Y., Peng, H., Wang, J., & Li, F. (2024). New insights into CAR t-cell hematological toxicities: Manifestations, mechanisms, and effective management strategies. Experimental Hematology & Oncology, 13, Article 110. https://doi.org/10.1186/s40164-024-00573-9
Zadik, Y., Raber-Durlacher, J. E., Epstein, J. B., Majorana, A., Miranda-Silva, W., Yang, S., Blijlevens, N. M. A., & Elad, S. (2025). MASCC/ISOO clinical practice statement: Dental evaluation and management prior to treatment for hematologic malignancies and CAR t-cell therapy. Supportive Care in Cancer, 33, Article 853. https://doi.org/10.1007/s00520-025-09845-4
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Krzysztof Opala, Jakub Krowiński, Julia Grzegorczyk
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
