Protocol Index	

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IP/OP PRO00038933 EMN30 / ARM A (TEC-LEN)	

Types:      Research Oncology Treatment
Synonyms:  ARM A, TEC, EMN30, SRI2

Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	HEIGHT AND WEIGHT	Interval: --	Occurrences: --	Comments:	Weight
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --			Labs
  	GGT	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	AMYLASE LEVEL	Interval: Once	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Labs
  	NURSING COMMUNICATION - DO NOT USE IN ORDER SETS	Interval: Until discontinued	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: Once	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: Once	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: Once	Occurrences: --			Labs
  	NURSING COMMUNICATION - DO NOT USE IN ORDER SETS	Interval: Until discontinued	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: Once	Occurrences: --		  	CD 4 SUBSET	Interval: Once	Occurrences: --			Labs
  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: Once	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: STAT	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	dexAMETHasone (DECADRON) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	diphenhydrAMINE (BENADRYL) tablet 50 mg	Dose: 50 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (0.06-0.3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 10 mg/mL 0.06 mg/kg (Treatment Plan)	Dose: 0.06 mg/kg	Route: subcutaneous	once for 1 dose			Offset: 60 Minutes	Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Emergency Medications
  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S			Instructions:	if rigors persist, contact MD				Day 3	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --			Labs
  	GGT	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	AMYLASE LEVEL	Interval: Once	Occurrences: --			Labs
  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	dexAMETHasone (DECADRON) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	diphenhydrAMINE (BENADRYL) tablet 50 mg	Dose: 50 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (0.06-0.3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 10 mg/mL 0.3 mg/kg (Treatment Plan)	Dose: 0.3 mg/kg	Route: subcutaneous	once for 1 dose			Offset: 60 Minutes	Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Emergency Medications
  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S			Instructions:	if rigors persist, contact MD				Day 7	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --			Labs
  	GGT	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	AMYLASE LEVEL	Interval: Once	Occurrences: --			Labs
  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	dexAMETHasone (DECADRON) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	diphenhydrAMINE (BENADRYL) tablet 50 mg	Dose: 50 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 1 hours prior to teclistamab			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 1.5 mg/kg (Treatment Plan)	Dose: 1.5 mg/kg	Route: subcutaneous	once for 1 dose			Offset: 60 Minutes	Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Emergency Medications
  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S			Instructions:	if rigors persist, contact MD				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	LDH	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	GGT	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	AMYLASE LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 1.5 mg/kg (Treatment Plan)	Dose: 1.5 mg/kg	Route: subcutaneous	once for 1 dose			Offset: 60 Minutes	Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	LDH	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	GGT	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	AMYLASE LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S						Day 7	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
				Day 15	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	LDH	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	GGT	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	AMYLASE LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
				Day 22	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	LDH	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	GGT	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	AMYLASE LEVEL	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PRO-CTCAE

Collection to cease upon start of subsequent
antimyeloma therapy. May be collected via
telephone contact when participant is not on site. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 4	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 5	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 6	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Procedures
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	For all participants:
 6, 12, and 24 months (±1 month) after C1D1.
Time of PD (unless this occurs within 1 month of another bone marrow aspiration).
For participants with suspected or confirmed CR or sCR, additional samples at:
Time of suspected CR or sCR (unless this occurs within 1 month of another bone marrow aspiration).
18, 30, 36, 48, and 60 months post C1D1 (±1 month), unless this occurs within 1 month of another bone marrow aspiration, until PD. See Table 26
		  	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	as clinically indicated
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 7	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 8	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 9	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 10	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 11	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 12	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Procedures
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	For all participants:
 6, 12, and 24 months (±1 month) after C1D1.
Time of PD (unless this occurs within 1 month of another bone marrow aspiration).
For participants with suspected or confirmed CR or sCR, additional samples at:
Time of suspected CR or sCR (unless this occurs within 1 month of another bone marrow aspiration).
18, 30, 36, 48, and 60 months post C1D1 (±1 month), unless this occurs within 1 month of another bone marrow aspiration, until PD. See Table 26
		  	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	as clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	Collect at 12 months (± 1 month) after C1D1 (on the day of bone marrow aspirate collection, if feasible).
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 13	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 14	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 15	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 16	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 17	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 18	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 19	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 20	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 21	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 22	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 23	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycle 24	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Procedures
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	For all participants:
 6, 12, and 24 months (±1 month) after C1D1.
Time of PD (unless this occurs within 1 month of another bone marrow aspiration).
For participants with suspected or confirmed CR or sCR, additional samples at:
Time of suspected CR or sCR (unless this occurs within 1 month of another bone marrow aspiration).
18, 30, 36, 48, and 60 months post C1D1 (±1 month), unless this occurs within 1 month of another bone marrow aspiration, until PD. See Table 26
		  	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	as clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Pharmacokinetic Instructions
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Table 4
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
Cycles 25,26	Repeat 2 times	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	Hold parameters per protocol:
·        ANC LESS than 1000/microL
·        Platelet LESS than 75/microL
.        Hemoglobin LESS than 8 g/dL
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Monitor for neurotoxicity, such as somnolence, confusion, hallucinations, blurred vision, and seizures. Notify the provider if any of these symptoms exist.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please contact provider if previous teclistamab does administered GREATER than 63 days ago as this may warrant restarting step-up dose schedule.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Please verify that patient is taking appropriate anti-viral and PJP prophylaxis. Contact MD if patient is not taking any anti-viral or PJP prophylaxis
-     Antiviral prophylaxis: valacyclovir, acyclovir
-     PJP prophylaxis: Sulfamethoxazole/Trimethoprim, pentamidine, atovaquone
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	10 mg once daily May increase to 15 mg once daily on C5D1 if 10 mg was tolerated.
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Study protocol initial lenalidomide dose: 10 mg PO daily.

Initial dosing based on renal function:
-         CrCl > 60 mL/min: 10 mg by mouth daily
-         CrCl 30-60 mL/min: 5 mg by mouth daily
-         CrCl 29 or below mL/min: 2.5 mg by mouth daily
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Chemotherapy
  	INV-Teclistamab Subcutaneous injection (1.5-3mg/kg) (MonumenTAL-6/Pro00038188/Ganguly) 90 mg/mL 3 mg/kg (Treatment Plan)	Dose: 3 mg/kg	Route: subcutaneous	once for 1 dose	Start: S			Instructions:	Prepared syringe(s) contains open label active teclistamab.  Administer as a subcutaneous injection.  Doses >2mL will be split into multiple syringes.  Each syringe injection site should be at least 2cm from other Teclistamab injections, and 10cm from Talquetamab administration site. Stable for 20 hours at room temperature.
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S							
EOT	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	PGIS.

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
					
FUP	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Exam

As clinical indicated.
			Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vital signs (temperature, pulse/heart rate, respiratory rate, blood pressure) and oxygen saturation.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Neurologic examination including ICE score.

C1D1 and As clinical indicated
			Research Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	24-hour UPEP
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Serum FLC
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	To perform Q28 days(±7days) during treatment phase. See Section 8.2, for details regarding
evaluations. Central laboratory (local laboratory assessments may be used under specified
circumstances [see Section 8.2.6]).
The sample for C1D1 may be collected <=3 calendar days prior to C1D1. NOTE: SPEP and UPEP
assessments will continue until 30 days after the start of the first subsequent antimyeloma therapy for participants with no PD or unconfirmed PD (ie, single instance of PD by laboratory assessment) while on treatment. For participants with measurable disease by light chain, serum FLC will
also continue during this period.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	SIFE/UIFE
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Imaging for disease evaluation.

See Section 8.2.4 for acceptable modalities.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	Assessment of soft-tissue plasmacytomas.

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Provider Communication
  	ONC PROVIDER COMMUNICATION 3	Interval: --	Occurrences: --	Comments:	MySIm-Q
EORTC-QLQ-C30
EQ-5D-5L 

Window for PRO data collection is 2 days prior
to dosing. Continue to be collected even if subsequent antimyeloma therapy is begun. 

See Section 8.2.5 for acceptable modalities and iand
instructions regarding biopsies. For participants with a history of plasmacytoma :
FUP Phase For assessment by physical examination (if applicable), Q8W (±7 days) until the plasmacytoma(s) meet CR criteria or PD or start of subsequent antimyeloma therapy
For assessment by radiology Q12W
(±14 days) until the plasmacytoma(s) meet CR criteria or PD or start of Subsequent antimyeloma therapy
As clinically indicated for other participants
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	MRU (medical resource utilization ).

Section 8.9. Collected continuously from the start of study treatment until 30 days after last dose or the start of subsequent antimyeloma therapy,
whichever is earlier.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Adverse Events.

Collected continuously from the time of signing of ICF until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier;
thereafter, continue to report any AEs/SAEs related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Secondary Primary Malignancy.

Collected continuously until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Therapy.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Symptomatic
Progression
Evaluation.

From 30 days prior to until 30 days after confirmed PD (or the start of subsequent antimyeloma therapy, whichever is earlier), progressionassociated
symptoms and concomitant medications will be documented in eCRF.

See Section 6.11. Collected continuously until 30 days after last dose or until the start of subsequent antimyeloma therapy, if earlier; thereafter, continue to report any concomitant therapy given for any AE/SAEs considered related to study treatment until end of study.
			Research Labs
  	IMMUNOGLOBULIN G, A, M	Interval: --	Occurrences: --	Comments:	Central laboratory (local laboratory assessments may be used under specified circumstances [see Section 8.2.6]).FUP Q16W (±14d) until PD
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	GGT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --			Labs
  	URIC ACID LEVEL	Interval: --	Occurrences: --	Comments:	As clinically indicated.
			Labs
  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --	Comments:	as clinically indicated.
		  	FIBRINOGEN	Interval: --	Occurrences: --	Comments:	as clinically indicated.
			Labs
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Women of childbearing potential (see Appendix 11) Serum or urine pregnancy test is acceptable. 
For all participants: within 10-14 days (serum) and within 24 hours (serum or urine) prior to
C1D1, Q28d thereafter (Q14d for women with irregular menses) and as clinically indicated.
For participants receiving Tec-Len (SRI2 Tec-Len and Arm A): additional testing within 10-
14 days of C2D1 and 24 hours prior to C2D1 (prior to starting lenalidomide) and Q7d during
the first month of lenalidomide therapy
			Labs
☐	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		☐	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HBV or HCV infection (see Section 8.3.5) For EOT and FUP : 3 and 6 months (±1 month) after last dose
		  	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		  	HEPATITIS B SURFACE ANTIBODY	Interval: --	Occurrences: --		  	HEPATITIS C VIRUS (HCV), QUANTITATIVE PCR	Interval: --	Occurrences: --			Labs
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Participants with history of HIV infection (see Section 8.3.5.4) For EOT and FUP : 3 and 6 months (±1 month) after last dose.
		  	HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1), QUANTITATIVE PCR	Interval: --	Occurrences: --		  	CD 4 SUBSET	Interval: --	Occurrences: --			Imaging
  	ECG 12-LEAD	Interval: --	Occurrences: --	Comments:	As clinically indicated
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	See Section 8.2.5
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Subsequent
antimyeloma therapy
		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Survival