Relapsed/Refractory Multiple Myeloma: Best Practices for Holding and Bridging Therapy

Dr. Joshua Richter and Dr. Marco Davila discuss practical considerations for holding and bridging therapy in patients with relapsed/refractory multiple myeloma (RRMM) who are preparing to receive CAR T-cell therapy. Dr. Davila explains that, whenever feasible, T-cell collection should occur before initiating holding therapy to preserve treatment options and avoid unnecessary delays. When holding therapy is required, he recommends selecting treatments that control disease while avoiding T-cell engagers and therapies targeting the same antigen as the planned CAR T-cell product, when appropriate, because of potential effects on T-cell function and treatment efficacy. For bridging therapy following cell collection, he reiterates that the primary objective is to maintain disease control rather than achieve a deep response. The faculty emphasize that limiting bridging therapy to the minimum necessary duration helps reduce treatment-related toxicity and prevents unnecessary delays to CAR T-cell infusion, reinforcing a patient-centered approach that prioritizes timely delivery of definitive cellular therapy in RRMM.