Relapsed/Refractory Multiple Myeloma: Case-Based Discussion — The Comorbid, Higher-Risk Patient, and Program Conclusions

Dr. Thomas Martin presents the final and most challenging case: an older patient being evaluated for BCMA-directed therapy after progression on prior anti-CD38 therapy, with baseline neuropathy, mild gait instability, recurrent infections, and significant caregiver concern about neurologic toxicity, infection, and logistics. Team Myeloma Masters favors a lower-intensity, potentially fixed-duration bispecific approach with dose attenuation and less frequent dosing to mitigate risk in a frail patient, while the panel stresses that IVIG alone does not address the full infection risk and that a more comprehensive antimicrobial prophylaxis strategy is warranted. Team Myeloma Mavericks raises the option of a non-BCMA-directed approach, including GPRC5D-targeted therapy or immunomodulatory and carfilzomib-based combinations, reinforcing that treatment must be individualized rather than forced into a single framework. The segment concludes with the award ceremony, in which Dr. Martin congratulates both teams, summarizes the trade-offs between one-time CAR T-cell therapy with its durability and cure potential and the off-the-shelf accessibility of bispecific antibodies, declares that patients are the true winners, and awards the trophy to the CAR T-cell team on the rationale that patients should first have the opportunity to consider cellular therapy.