Relapsed/Refractory Multiple Myeloma: Case-Based Discussion — Rapidly Progressive Earlier-Relapse Disease

Dr. Thomas Martin introduces the third section, a rapid case-based discussion applying the program's themes to real-world scenarios, and presents the first case: a fit, transplant-exposed patient progressing on lenalidomide maintenance with rapidly progressive, symptomatic, high-risk disease requiring prompt intervention. Team Myeloma Mavericks approaches the case by prioritizing immediate disease control and a path to CAR T-cell therapy, recommending prompt apheresis with bridging, or community-initiated holding therapy using regimens that do not impair stem cell or T-cell collection such as daratumumab, carfilzomib, and dexamethasone while avoiding agents that compromise apheresis. Team Myeloma Masters counters that disease tempo is largely neutral to the CAR T-cell versus bispecific choice once effective holding therapy is underway, making the decision one of logistics, safety, and patient preference given the comparable efficacy of both approaches. The moderated exchange emphasizes access gaps across the country, the option of adding a non-BCMA agent for additional control, and the recognition that this is precisely the patient at highest risk of attrition, making the second-line decision especially consequential.