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Multiple Myeloma

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Panelists discuss how, when considering earlier lines of CAR T-cell therapy for relapsed/refractory multiple myeloma, key institutional factors include patient fitness/age, cytogenetic risk status, prior therapy response duration, and BCMA expression levels. Manufacturing timelines, financial considerations, and center-specific outcomes data also influence timing decisions. For patients receiving early-line CAR T therapy, subsequent treatment options typically focus on novel agent combinations or clinical trials exploring additional cellular therapies, with choices guided by response duration to CAR T and the patient’s individual disease characteristics and treatment goals.

Panelists discuss how, for second-line treatment of relapsed/refractory multiple myeloma (R/R MM), patients suitable for CAR T-cell (cilta-cel vs ide-cel) therapy typically have a poor prognosis with limited response to prior therapies. Institutional guidelines focus on factors such as prior lines of therapy, organ function, and cytogenetics. Non-medical factors, such as geographic access and financial constraints, also influence CAR T-cell therapy referral eligibility.

Panelists explain how CAR-T cell therapy works and describe the treatment process, discussing whether CAR -T is considered a complex procedure at their institution or if the logistics have been streamlined into clinical workflows, and they also detail their institution's approach to bridging therapy for patients awaiting CAR-T manufacturing and infusion, including whether patients are managed in-house or sent back to community centers.

Panelists discuss which patients are considered for CAR-T therapy in second-line treatment for relapsed/refractory multiple myeloma (R/R MM) (cilta-cel vs ide-cel), describe the specific criteria and institutional guidelines used to determine patient eligibility, and explore how non-medical factors like such as location and financial considerations impact patient selection, while also outlining the typical CAR-T referral process from community physician outreach to patient evaluation and selection.

4 experts are featured in this series.

Panelists discuss how recent pivotal trials like PERSEUS and CASSIOPEIA demonstrate superior outcomes with daratumumab-based quadruplet and triplet combinations compared with standard regimens in transplant-eligible newly diagnosed multiple myeloma patients, particularly showing improved progression-free survival when daratumumab is added to VRd (bortezomib, lenalidomide, and dexamethasone) or VTd (bortezomib, thalidomide, and dexamethasone) backbones.