Case Discussion: Selecting BCMA Bispecific Therapy for a Patient With Relapsed/Refractory Multiple Myeloma and Limited Access to CAR-T

The faculty discuss the management of a patient with relapsed/refractory multiple myeloma (R/R MM) who has received four prior lines of therapy but faces significant logistical barriers to CAR-T treatment because of limited caregiver support and distance from a cellular therapy center. Dr. Ridhi Gupta recommends an off-the-shelf BCMA bispecific antibody, emphasizing its accessibility, rapid treatment initiation, and feasibility for patients who cannot relocate for CAR-T therapy. Dr. Prashant Kapoor highlights the importance of selecting a specific BCMA bispecific antibody based on the experience and resources available at the patient's local treatment center to facilitate continuity of care between academic and community practices. The faculty also discuss circumstances in which GPRC5D-directed therapy may be considered, balancing infection risk and quality-of-life considerations against the potential to preserve future treatment options. Overall, the panel emphasizes tailoring treatment selection to individual patient circumstances while ensuring timely access to effective immunotherapy for relapsed/refractory multiple myeloma.