Determining Eligibility for Second Line vs Third Line CAR T-Cell Therapy in Multiple Myeloma

This segment focuses on how clinicians differentiate which patients with relapsed or refractory multiple myeloma are suited for second line CAR T-cell therapy versus those better placed in the third line setting. Dr. Kaur explains that second line use is generally prioritized for patients with functionally high risk disease, early relapse after autologous transplant, aggressive clinical features, or high risk cytogenetics, particularly when they are younger and have rapidly progressive disease that is unlikely to respond well to standard therapies. In practice, many patients are not referred early enough to receive CAR T in the second line and will present only at their third relapse. At that point, both idecabtagene vicleucel and ciltacabtagene autoleucel remain appropriate options. The ultimate decision is shaped by disease biology, pace of relapse, patient preference, prior therapies, and the need to balance efficacy with toxicity risks. Shared decision making plays a central role in determining the optimal treatment line.