Case Discussion: Selecting a Bispecific for a High-Risk, Rapidly Progressing Patient

In this clinically rich segment, the panel dissects a complex case: a 72-year-old woman with RRMM, high-risk cytogenetics (del[17p], +1q), extramedullary disease, rapid progression, and 5 prior lines of therapy. Each panelist approaches the case through their own clinical lens, illustrating how bispecifics are chosen for patients with aggressive disease biology and urgent need for disease control.

Mohan Krishnamachary, MD, emphasizes that despite the patient’s age, her performance status and limited comorbidities make her an excellent candidate for an aggressive, high-response-rate therapy. For him, this is the type of patient where rapid remission induction is essential, and bispecifics offer that capability.

Joseph walks through treatment sequencing logic: although CAR T-cell therapy would otherwise be a strong consideration in a fit 72-year-old, the patient’s rapid progression makes CAR T impractical due to manufacturing delays and challenges achieving adequate disease control before apheresis. She also highlights emerging data showing favorable outcomes with linvoseltamab in patients with extramedullary disease, reinforcing its selection here.

Nooka structures his analysis using patient, disease, and treatment-related factors. The patient meets all FDA criteria; she has no contraindications; and she has adequate social support for outpatient monitoring. This makes her not only eligible but ideal for bispecific therapy.

Krishnamachary adds that among the approved agents, he would favor linvoseltamab for its less burdensome dosing schedule and reduced hospitalization requirements, an advantage in real-world settings.

Through this case, the panel demonstrates how bispecifics are increasingly becoming the preferred option for high-risk RRMM patients who need rapid disease control, particularly when CAR T-cell therapy is not immediately feasible.