Expert Perspectives on Sequencing BCMA-Directed Therapies in Relapsed/Refractory Multiple Myeloma

Following the presentation of the real-world sequencing analysis, the faculty discuss how these findings align with their own clinical experience treating relapsed/refractory multiple myeloma (R/R MM). Dr. Harsh Parmar, Dr. Ridhi Gupta, and Dr. Prashant Kapoor explore the factors that influence sequencing decisions after prior BCMA-directed therapy, emphasizing that treatment selection must be individualized based on disease biology, prior therapy, pace of relapse, patient fitness, and treatment goals. The panel discusses the potential challenges of sequential BCMA-directed therapy, including T-cell exhaustion and antigen loss, while highlighting situations in which switching therapeutic targets, enrolling patients in clinical trials, or using alternative bridging strategies may be appropriate. Faculty also underscore the importance of early referral to myeloma specialists, shared decision-making, and thoughtful patient counseling regarding the benefits, risks, and logistical considerations associated with CAR-T cell therapy and BCMA bispecific antibodies. The discussion concludes by acknowledging that optimal sequencing remains an evolving area of investigation as new evidence continues to emerge in relapsed/refractory multiple myeloma.