Sequencing CAR T-Cell Therapy With Radiation in High-Risk Multiple Myeloma

As radiotherapy becomes more strategically integrated around CAR T-cell therapy in multiple myeloma, clinicians face a choice between bridging radiotherapy before infusion and consolidative radiation afterward, particularly for patients with high-risk disease features.

Alexandra Dreyfuss, MD, MS, an assistant professor in the Department of Radiation Oncology at the University of Miami Sylvester Comprehensive Cancer Center, spoke with CancerNetwork^® at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting about how she weighs these 2 approaches given the absence of comparative data on which strategy is more effective. She noted that patients with certain high-risk features may be more suitable to receive radiotherapy earlier, while those with fewer risk factors may be eligible to initiate CAR T-cell therapy prior to radiation.

Transcript:

CancerNetwork: How do you see radiotherapy fitting in as a bridging strategy before infusion vs a consolidative strategy afterward for high-risk disease sites?

Dreyfuss: I think both, at this point, are considered very viable options. I don’t know that we have data to suggest one is more effective than the other. In a preliminary way, the way I’d think about it is that for patients with certain higher-risk features, whether systemic or radiologic high-risk features, incorporating radiation earlier might make sense. Number one, we have a clearer target of what we’d want to treat with radiation, and number two, if a patient is higher risk, they probably need more therapy to get them to a place where they could respond better to CAR T.

Whereas for a patient with fewer risk factors prior to CAR T, it might make more sense to see how they do with CAR T first, and if they have an incomplete response, at least in the early setting, intervene with radiation then, potentially sparing some patients from needing any additional therapy. That’s how I’d think about it now. I don’t know that we can say one approach is better than the other at this point.