Shared Clinical Decision-Making in CAR T Therapy for R/R MM
Panelists discuss how shared clinical decision-making in chimeric antigen receptor (CAR) T-cell therapy involves seamless coordination between physicians and nurse coordinators who streamline the referral process for patients after first-line therapy failure, with coordinators managing logistics like condensing multiple appointments, arranging travel and lodging benefits through CAR T companies for out-of-state patients, providing clear communication in “nurse talk” rather than medical jargon, and emphasizing that the referral process is straightforward—encouraging oncologists not to wait but to send patients immediately after 1 line of therapy so the team can handle insurance approval and T-cell collection while patients return home during the 4- to 8-week manufacturing period.
The evolution of multiple myeloma (MM) treatment has transitioned from primarily chemotherapy-based and targeted therapies to include innovative immunotherapy options like CAR T. Traditional treatment approaches included combinations such as cyclophosphamide, bortezomib, and dexamethasone, followed by stem cell transplantation, with second-line standard care typically involving daratumumab-based regimens combined with lenalidomide (Revlimid) and dexamethasone or pomalidomide and dexamethasone. CAR T therapy represents a significant advancement by offering patients an alternative to continuous chemotherapy regimens.
The care coordination process for CAR T therapy involves comprehensive logistical planning to minimize patient burden, which is particularly important given that many patients travel significant distances for treatment. The coordination team works to consolidate pretesting, collection procedures, and consent processes to reduce multiple trips, which is especially beneficial for patients living 3 to 6 hours away near state borders. CAR T companies provide valuable travel and lodging benefits, covering hotel stays during pretesting phases and the mandatory 30-day postinfusion monitoring period. The coordinator’s role involves scheduling all necessary procedures, including bone marrow biopsies when needed, while maintaining clear communication with patients about upcoming appointments and procedures.
Patient education and communication are central to successful CAR T coordination, with coordinators translating complex medical information into understandable language after physician consultations. Many patients have never heard of CAR T therapy, requiring comprehensive explanation of the entire process. The referral process has been streamlined for efficiency, with the recommendation that patients who have received 1 line of therapy and show signs of relapse should be referred immediately rather than waiting. The current timeline involves 6 to 8 weeks for T-cell manufacturing, though this has recently been reduced to as little as 4 weeks. During the manufacturing period, patients can return home and resume normal activities until their engineered cells are ready for reinfusion, making the treatment more accessible and less disruptive to patients’ lives.
Newsletter
Stay up to date on recent advances in the multidisciplinary approach to cancer.
