Exploring T-Cell Fitness Strategies to Optimize Clinical Outcomes in RRMM

Physician Summary: Bridging Strategies to Preserve or Enhance T-Cell Fitness Prior to CAR T

T-cell fitness is a key determinant of CAR T therapy success. Certain bridging strategies may help preserve or even enhance T-cell function during the waiting period before CAR T infusion.

Helpful Bridging Strategies:

• Selinexor: Has shown immunomodulatory effects on the tumor microenvironment and may enhance T-cell function, according to emerging data. It’s a viable option for disease control without significant T-cell suppression.
• IMiDs (eg, pomalidomide): Can support T-cell activation and persistence, and may boost CAR T efficacy when used prior to infusion.
• Immune checkpoint inhibitors (eg, nivolumab): Early data suggest potential to restore exhausted T cells and improve CAR T outcomes, though this remains investigational.

Key Takeaway: When bridging is required, selecting agents like selinexor, IMiDs, or possibly ICIs may offer dual benefit—disease control and preservation of T-cell fitness—improving the likelihood of a successful CAR T response.