Future Directions and Collaborations in Multiple Myeloma
Panelists discuss how future directions in multiple myeloma include exciting developments like bispecific T-cell engagers (BiTEs) targeting B-cell maturation antigen (BCMA) and GPRC5D, dual-target chimeric antigen receptor (CAR) T therapies, and revolutionary in vivo CAR T approaches, while emphasizing the importance of nurse education and advocacy, compassionate patient-centered care, and a collaborative community approach where academic centers support community oncologists through accessible communication and shared care, ultimately working toward the goal of curing more patients, as evidenced by one-third of ciltacabtagene autoleucel (cilta-cel) recipients remaining in remission 5 years later without additional therapy.
The future of multiple myeloma treatment is rapidly evolving with several groundbreaking immunotherapy approaches in development. Beyond current CAR T therapies, researchers are working on BiTEs that connect BCMA or GPRC5D targets to T cells, dual-target CAR T therapies that simultaneously attack 2 different myeloma antigens, and dual-target BiTEs for enhanced efficacy. Most revolutionary is the concept of in vivo CAR T therapy, recently published in Lancet Oncology, where patients would receive a simple injection containing viral vectors or a genetic code that programs their own immune cells to become CAR T cells without requiring cell collection, engineering, or manufacturing processes.
The care team emphasized the critical importance of education and advocacy, particularly for nurses working with patients with multiple myeloma in community settings. Nurses are uniquely positioned as patient advocates due to their frequent patient contact and gentle communication style, making them ideal for identifying candidates for advanced therapies like CAR T. The team stressed that most patients would qualify for CAR T therapy, making it essential for health care providers to be knowledgeable about these options and proactive in referring appropriate candidates for evaluation.
The patient’s closing message focused on encouraging other patients with multiple myeloma to explore CAR T options while emphasizing the importance of self-advocacy and maintaining hope. She found CAR T less invasive than stem cell transplantation, with faster healing and freedom from continuous chemotherapy. Her advice centered on researching treatment options, consulting knowledgeable specialists, and believing in one’s strength to overcome challenges. The medical team’s final message reinforced that excellent therapy and good outcomes should be expected by all patients, with current data showing one-third of cilta-cel recipients remaining in remission 5 years post treatment without additional therapy. This represents significant progress toward the ultimate goal of curing multiple myeloma, offering genuine hope for sustained remission and improved quality of life.
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