Hans Lee, MD

The faculty define holding and bridging therapy, discuss how they coordinate it with the referring practice, and walk through the timeline.

A panelist describes how the treating center, local oncologist, patient, and caregivers share responsibility for monitoring after CAR T-cell therapy, including warning symptoms, immune monitoring, and infection prevention.

One panelist describes the consent conversation with patients and caregivers, including how the treatment works, what to expect from outcomes, the practical process, and side effects such as cytokine release syndrome, ICANS, cranial nerve palsy, colitis, and movement disorders.

The faculty discuss a recent exchange in Nature Reviews Clinical Oncology on the role of CAR T-cell therapy and where it fits in the treatment sequence, including concerns about toxicity and how recognition and management of these toxicities have evolved.

The moderator reviews a guideline recommendation on CAR T-cell therapy and T-cell engagers at first relapse, and one panelist describes how it compares with their practice, including the rationale for sequencing and the questions that remain open.

Panelists discuss which patients at first relapse make them think of CAR T-cell therapy and which make them pause, including disease burden and the role of holding and bridging therapy, age and fitness, kidney function, and caregiver availability.

The faculty consider how they would answer a patient who is 5 years out from a single infusion in sustained MRD-negative remission and asks whether they are cured.

The faculty consider what level of follow-up they consider meaningful for a one-time therapy, pointing to the International Myeloma Working Group consensus benchmark of sustained minimal residual disease (MRD) negativity with imaging negativity.

The program opens with panelist introductions and an overview of ciltacabtagene autoleucel (ciltacel), a BCMA-directed autologous CAR T-cell therapy given as a single infusion and approved for adults with relapsed or refractory multiple myeloma who have received at least 1 prior line of therapy, including a proteasome inhibitor and an immunomodulatory agent, and are refractory to lenalidomide.

Dr. Thomas Martin presents the final and most challenging case: an older patient being evaluated for BCMA-directed therapy after progression on prior anti-CD38 therapy, with baseline neuropathy, mild gait instability, recurrent infections, and significant caregiver concern about neurologic toxicity, infection, and logistics.

Dr. Thomas Martin presents the second case: a younger, fit, lenalidomide-refractory patient with biochemical and radiologic progression after frontline therapy who is relatively asymptomatic with controlled disease burden and is an appropriate candidate for either CAR T-cell or bispecific therapy, with no urgency to treat.

Dr. Thomas Martin introduces the third section, a rapid case-based discussion applying the program's themes to real-world scenarios, and presents the first case: a fit, transplant-exposed patient progressing on lenalidomide maintenance with rapidly progressive, symptomatic, high-risk disease requiring prompt intervention.

The face-off debate continues with the second and third questions, moderated by Dr. Thomas Martin.

Dr. Thomas Martin opens the second section, the face-off debate, and introduces the first debate question on how clinicians should approach treatment selection between CAR T-cell therapy and bispecific antibody-based approaches in second-line disease.

Team Myeloma Mavericks presents the sixth abstract review, a real-world and safety-focused discussion of BCMA-directed therapies in earlier-relapse disease, closing out the data-and-landscape section.

Team Myeloma Mavericks presents the fifth abstract review, the updated long-term analysis of CARTITUDE-4 evaluating ciltacabtagene autoleucel against standard triplet therapy in earlier-relapse disease, framed by the durable remissions and cure signal seen in longer-term CARTITUDE-1 follow-up.

Dr. Thomas Martin introduces the fourth abstract review, and Team Myeloma Masters presents MajesTEC-9, the phase 3 study of teclistamab monotherapy versus investigator's choice of standard, non-CD38-containing regimens in patients who are both lenalidomide- and anti-CD38-refractory after prior lines of therapy.

Dr. Thomas Martin transitions the panel to the third abstract review, and Team Myeloma Masters presents real-world treatment patterns and outcomes in lenalidomide-refractory relapsed/refractory multiple myeloma drawn from the Flatiron registry.

Segment opens with the closing moments of the CAR T-cell therapy quality-of-life argument before Dr. Thomas Martin transitions to the second abstract review.

Hans C. Lee, MD, discussed how community oncologists with limited access to MRD testing can think about the new IMS/IMWG definition of cure in myeloma.

Hans C. Lee, MD, discussed how he monitors patients with multiple myeloma who achieve deep, sustained MRD negativity after coming off therapy.

Treatment until progression may not be the way forward with bispecific antibodies, according to Hans Lee, MD.

Hans Lee, MD, said it is only a matter of time before bispecific antibodies move into the newly diagnosed multiple myeloma setting.

Dr. Saad Usmani reviews key findings from the phase 3 CARTITUDE-4 trial and discusses the growing role of ciltacabtagene autoleucel (cilta-cel) in patients with second-line and earlier-relapse relapsed/refractory multiple myeloma. The discussion highlights the study population, including patients with lenalidomide-refractory disease and high-risk clinical features, as well as the significant progression-free survival benefit observed with BCMA-directed CAR T-cell therapy compared with standard triplet regimens. Dr. Usmani and the panel examine the depth and durability of response, including high rates of complete response and sustained MRD negativity, and discuss the concept of treatment-free remission as a unique advantage of CAR T-cell therapy. Faculty also explore practical considerations such as patient selection, manufacturing timelines, bridging therapy, disease burden control, and quality-of-life outcomes. The conversation further addresses important safety considerations, including cytokine release syndrome, neurotoxicity, Parkinsonism-like events, immune effector cell-associated enterocolitis, access challenges, and the logistical barriers associated with delivering CAR T-cell therapy in real-world multiple myeloma practice.

Dr. Thomas Martin opens this Cancer Network FACE-OFF program by introducing a debate-style discussion focused on one of the most rapidly evolving areas in relapsed/refractory multiple myeloma: treatment selection between BCMA-directed CAR T-cell therapy and bispecific antibody-based approaches in second-line and earlier-relapse disease. He outlines the unique format of the program, which combines clinical data review, expert debate, and case-based discussion to explore real-world treatment decision-making. Dr. Martin introduces Team Myeloma Mavericks, led by Dr. Saad Usmani and featuring Dr. Surbhi Sidana and Dr. Gurbakhash Kaur, and Team Myeloma Masters, led by Dr. Peter Voorhees with Dr. Amrita Krishnan and Dr. Hans Lee. The segment concludes with an overview of the pivotal studies that will frame the discussion, including CARTITUDE-4, MajesTEC-3, and MajesTEC-9, highlighting how emerging efficacy, durability, safety, and sequencing data are reshaping treatment strategies for patients with relapsed/refractory multiple myeloma.

Experts discuss the growing evidence supporting outpatient administration of bispecific antibodies in multiple myeloma, emphasizing the need for multidisciplinary collaboration, patient education, and clear emergency protocols to safely expand this convenient, off-the-shelf treatment approach across disease stages, highlighting that partnerships with experienced centers and gradual implementation strategies are key to successful adoption and improved patient care.

Experts discuss the feasibility and safety of outpatient bispecific antibody treatment for multiple myeloma, emphasizing the importance of careful patient selection, robust support systems, and multidisciplinary collaboration to manage potential complications such as cytokine release syndrome (CRS) and ensure timely care, highlighting that with these measures, outpatient administration can safely expand access while maintaining efficacy and patient convenience.

Experts discuss the significant advancement of outpatient and hybrid dosing strategies for bispecific antibodies such as teclistamab in multiple myeloma, highlighting that with careful patient selection, multidisciplinary support, and proactive monitoring, these approaches maintain efficacy and safety comparable to inpatient care while enhancing patient convenience and expanding access.

Experts discuss new real-world data supporting the safety and effectiveness of outpatient and hybrid step-up dosing of teclistamab in relapsed or refractory multiple myeloma, showing strong response rates, durable disease control, and manageable toxicity and reinforcing the feasibility of administering bispecific therapies beyond inpatient settings and expanding access in community care.

Experts discuss real-world evidence demonstrating that bispecific antibodies such as teclistamab can be safely and effectively administered in community oncology settings using hybrid care models, with robust outcomes even in non–trial-eligible patients and manageable safety profiles that support broader access beyond academic centers.