Determining Proper Sequencing for Cellular Therapies in Multiple Myeloma

Evaluating patients with multiple myeloma on a case-by-case basis may be key for optimally sequencing CAR T-cell therapy and bispecific antibodies across different lines of therapies, according to Al-Ola A. Abdallah, MD.

CancerNetwork^® spoke with Abdallah, an associate professor of Medicine and the director of the Plasma Cell Disorder Clinic in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Medical Center, at the 2025 National Immune Cell Effector Therapy (ICE-T) Conference about considerations for treatment decision-making among patients with multiple myeloma and other plasma cell disorders.

Although it appears to be a “no-brainer” to administer CAR T-cell therapy to all patients who experience a relapse following second-line therapy, Abdallah described how assessing each patient’s case on an individual level may provide the best possible benefit with these agents. Beyond cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), long-term toxicities like infection and secondary primary malignancies may pose risks to consider when determining optimal treatment choices for patients.

Transcript:

The CAR T-cell [therapies] and the bispecifics are emerging quickly. We don’t have a great answer [for sequencing]. The challenges here are that when CAR T-cell [therapy] has been approved, it was after 4 lines of therapy. It was an easy decision about how to give it to these patients. Now, CAR T has moved to a second line of therapy. The challenges are, do we give that to patients directly or not, or wait until they relapse a second or third time? Mainly, [that is because] there are some [adverse] effects that we’re still concerned about, and we’re not talking about the CRS and ICANS. Mainly, we’re talking about other long-term [adverse] effects like risk of infection as well as the risk of the other concerning [adverse] effects like secondary malignancy.

One of the major questions here is, “Do we have to give every single patient who have relapsed after a second line of therapy CAR T-cell [therapy]?”The word is that it’s a no-brainer. I don’t think that’s the right answer. We should have to evaluate case-by-case in order to provide the best benefit for our patients for using the CAR T-cell therapy.