Discussing Current Gaps in Multiple Myeloma Care

The treatment landscape for relapsed or refractory multiple myeloma has evolved rapidly with the introduction of novel therapies, particularly T-cell–redirecting agents such as bispecific antibodies and chimeric antigen receptor T-cell therapies. These have shown significant efficacy in heavily pretreated patients, including those who have triple-class–refractory disease. However, with a growing number of effective options, a key challenge now lies in determining the optimal sequencing of therapies and improving access to these treatments across different health care settings.

Despite the promise of these advanced therapies, practical challenges remain. Step-up dosing protocols, used to mitigate cytokine release syndrome associated with bispecific antibodies such as teclistamab, require close monitoring and often hospitalization. This can create logistical burdens for both patients and institutions, especially in nonacademic or community settings. Efforts are underway to shift toward outpatient administration and develop streamlined protocols, including the use of prophylactic medications, to make these treatments more broadly accessible without compromising safety.

Another major consideration is the early recognition and management of disease progression and treatment-related toxicities. Delays in diagnosing relapse or addressing adverse effects such as neuropathy or cytopenias can limit a patient’s ability to tolerate future therapies. Proactive monitoring and timely intervention are essential to preserve patient fitness and maintain access to newer lines of therapy. Overall, although the therapeutic arsenal for multiple myeloma has expanded, addressing care delivery gaps and tailoring strategies to individual patient needs remain central to improving real-world outcomes.