Relapsed/Refractory Multiple Myeloma: Case-Based Discussion — The Fit, Immunotherapy-Eligible Patient in Second Line

Dr. Thomas Martin presents the second case: a younger, fit, lenalidomide-refractory patient with biochemical and radiologic progression after frontline therapy who is relatively asymptomatic with controlled disease burden and is an appropriate candidate for either CAR T-cell or bispecific therapy, with no urgency to treat. Team Myeloma Mavericks frames this as an ideal CAR T-cell candidate, prioritizing sequencing, T-cell fitness, and preservation of future options, and favoring unhurried apheresis with adequate bridging to maximize disease control before cellular therapy and the prospect of a durable treatment-free interval. Team Myeloma Masters emphasizes individualization and the off-the-shelf convenience of a bispecific for a young, active patient, noting that lifestyle and scheduling flexibility may legitimately lead such a patient to prefer a bispecific approach much as some patients defer transplant. The moderated discussion centers on honest communication of a small but serious toxicity risk, patient risk tolerance, and the importance of a nuanced, shared decision. The removable moment is a brief on-camera aside and pause before the panel responds to a deliberately leading question.