Sequencing Strategies and Safety Priorities for High Risk, Bispecific Exposed Patients Preparing for CAR T-Cell Therapy

This segment focuses on assessing CAR T-cell therapy candidacy in a patient with high risk multiple myeloma who recently received a BCMA bispecific antibody. Dr. Raje explains that prior bispecific therapy does not exclude CAR T eligibility, but the timing of exposure is important because bispecific driven T-cell exhaustion can compromise collection quality and response. Clinical judgment centers on disease tempo, duration off bispecific therapy, and residual T-cell fitness. Dr. Kaur outlines additional assessments needed before CAR T, including monitoring for infections such as CMV, evaluating immunoglobulin levels, and considering sequencing tools or soluble BCMA levels when available. She also emphasizes the need to set clear expectations for working patients regarding the timeline from referral to authorization, apheresis, manufacturing, and infusion, noting that even with process efficiencies, patients still require focused time away from work. This segment highlights how thoughtful evaluation and early discussion can optimize readiness for CAR T-cell therapy.