Discussing Guidelines, New Data, and Earlier Referrals in Multiple Myeloma

In the newest edition of Oncology On the Go, Matthew J. Frigault, MD, joined Adam D. Cohen, MD, to discuss the evolving cellular therapy paradigm in multiple myeloma practice. They highlighted what the newest guidelines and long-term clinical trial data mean for patient care and how academic centers and community practices can collaborate more effectively.

The conversation opened with a look at how recent updates to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for multiple myeloma position CAR T-cell therapy in early relapse.¹ Frigault noted that the guidelines now support referral for CAR T-cell therapy as early as the second line in patients who are refractory to lenalidomide (Revlimid), emphasizing the utility of agents such as ciltacabtagene autoleucel (cilta-cel; Carvykti).

The experts also touched upon the implications of updated findings from cohort A of the phase 2 CARTITUDE-2 trial (NCT04133636), in which investigators assessed cilta-cel in patients with lenalidomide-refractory disease following 1 to 3 prior lines of therapy.² With all patients now beyond 5 years of follow-up, 10 of 20 were alive and showed no progression after a single infusion without any further therapy, although Cohen cautioned that the cohort is small and that long-term follow-up data from the phase 3 CARTITUDE-4 trial (NCT04181827) are needed to confirm these findings.

Early referral of patients for cellular therapy was also a key point, as Frigault described how less heavily pretreated populations experience better outcomes and that those with lower disease burden and better functional status have shown improved efficacy, fewer toxicities, and lower long-term mortality after CAR T-cell therapy. Looking toward the future of the field, Frigault and Cohen detailed how dual-targeting CAR T-cell products, first-line trials comparing CAR T-cell therapy with autologous stem cell transplant, and other novel modalities may continue to evolve the field and introduce even more therapeutic options.

Frigault is clinical director of the Cellular Immunotherapy Program at Mass General Brigham Cancer Institute. Cohen is director of Myeloma Immunotherapy and professor of medicine at the Hospital of the University of Pennsylvania.

References

1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Multiple Myeloma. Version 2.2027. National Comprehensive Cancer Network. September 24, 2026. Accessed October 21, 2026. https://tinyurl.com/47x35wch
2. Cohen AD, Mateos M-V, Cohen YC, et al. Long-term (≥5-Year) remission and survival with ciltacabtagene autoleucel (Cilta-Cel) in relapsed/refractory multiple myeloma (RRMM) with 1-3 prior lines of therapy: CARTITUDE 2 Cohort A. Presented at: 23rd International Myeloma Society Annual Meeting; September 23-26, 2026; Glasgow, Scotland. Poster PA-288.