Managing Toxicity Expectations and Sequencing Considerations for CAR T-Cell Therapy in Multiple Myeloma

This segment examines how clinicians prepare patients and caregivers for the CAR T experience and make sequencing decisions in scenarios involving rising disease burden or prior BCMA therapy. Dr. Raje explains that the major acute toxicities, including cytokine release syndrome and ICANS, occur early after infusion and almost always while patients are under close supervision. She outlines how predictable kinetics and available therapeutic interventions help reduce patient anxiety and allow caregivers to anticipate short term monitoring needs. The experts also discuss how prior BCMA bispecific exposure may reduce T-cell fitness, potentially affecting CAR T efficacy, reinforcing the value of early referral. Dr. Kaur highlights the risks of delaying evaluation, including further cytopenias, worsening organ function, and loss of eligibility, especially in fast progressors. The segment stresses that proactive timing, transparent toxicity counseling, and individualized sequencing are essential to achieving optimal outcomes.