Long-Term Monitoring, Prophylaxis, and Vaccination After Cilta-Cel

Doris Hansen, MD, and Prerna Mewawalla, MD, discuss long-term monitoring, infection prophylaxis, and vaccination after ciltacabtagene autoleucel (cilta-cel) therapy for patients with multiple myeloma. They describe a follow-up schedule that may allow patients to leave the academic center after approximately 3 weeks, depending on infection, cytopenias, or lymphocytosis that could signal delayed toxicity. Patients are typically monitored weekly during the first month based on blood count recovery, followed by monthly visits through month 3. At month 3, restaging with positron emission tomography, bone marrow biopsy, and myeloma laboratory testing coincides with initiation of a vaccination series. Follow-up then occurs approximately every 3 months for 1 to 2 years. The discussion also covers prophylaxis, including acyclovir for at least 1 year, Pneumocystis jirovecii prophylaxis beginning around 1 month and generally continuing for at least 6 months, and monthly intravenous immunoglobulin, often administered in the community, for approximately 6 months to 1 year depending on immunoglobulin levels and infection risk. Close coordination with community providers remains essential.