Ciltacabtagene Autoleucel Manufacturing, Debulking, and Bridging in Multiple Myeloma

Doris Hansen, MD, and Prerna Mewawalla, MD, discuss ciltacabtagene autoleucel manufacturing, disease debulking, and bridging therapy before CAR T-cell infusion in patients with multiple myeloma. Dr. Hansen describes the treatment process, including vital organ testing, T-cell collection by apheresis, commercial manufacturing, and infusion. She explains that manufacturing, which previously could take up to 10 weeks, now generally takes approximately 4 weeks, allowing greater emphasis on reducing disease burden before infusion. Dr. Hansen describes a goal of achieving a very good partial response or better before ciltacabtagene autoleucel infusion and notes that bridging therapy may continue for 2 months or longer when needed. Dr. Mehwawala discusses the role of bridging strategies and the importance of controlling disease while patients await treatment. Dr. Hansen identifies talquetamab as an effective bridging option because it targets a different antigen from B-cell maturation antigen-directed cellular therapy and discusses cell-based combinations as additional options for disease control before infusion.