Relapsed/Refractory Multiple Myeloma: Safety and Real-World Management of BCMA-Directed Therapies

Team Myeloma Mavericks presents the sixth abstract review, a real-world and safety-focused discussion of BCMA-directed therapies in earlier-relapse disease, closing out the data-and-landscape section. The presentation reviews the movement disorder and Parkinsonism-like toxicities associated with CAR T-cell therapy, including their typically subtle early presentation, characteristic timing, reliance on clinical diagnosis and neurology partnership, and the emerging, increasingly effective management strategies such as high-dose cyclophosphamide, intrathecal chemotherapy, and JAK inhibition, alongside immune effector cell-associated enterocolitis and second primary malignancies. The importance of holding and bridging therapy for disease control, and the logistics of early referral from community to academic centers, are emphasized. Team Myeloma Masters offers rebuttal, arguing that a bispecific approach avoids these considerations and the need for specialized neurologic expertise, and raising the observed rates of secondary hematologic malignancy with cellular therapy. The exchange, moderated by Dr. Martin, extends into non-relapse mortality with both modalities, the maturity and follow-up differences between the CAR T-cell and bispecific datasets, and the open question of optimal sequencing to maximize combined progression-free survival across successive lines, all within a fair-balance framing.