Prior BCMA and Bispecific Therapies and Their Impact on CAR T Sequencing in Multiple Myeloma

This segment explains how prior exposure to BCMA directed agents and bispecific T cell engagers can influence CAR T cell therapy planning in multiple myeloma. Dr. Raje and colleagues emphasize that prolonged or recent bispecific use can drive T cell exhaustion and reduce the quality of cells available for manufacturing. When feasible, clinicians should consider offering BCMA directed CAR T before prolonged bispecific therapy to preserve T cell fitness. If a patient has received a bispecific, a window off the agent before collection is recommended, often two to three months when clinically possible, and use of non BCMA bridging or holding regimens may protect T cell function while disease is controlled. Teams should monitor infection risk closely and consider soluble BCMA or sequencing assays when available to assess antigen status. Real world experience shows collection is sometimes successful after bispecific exposure but outcomes may be suboptimal. Early referral and individualized sequencing discussions remain essential for optimal patient selection and timing.