Relapsed/Refractory Multiple Myeloma: Bridging Therapy Before CAR T-Cell Therapy

Dr. Joshua Richter and Dr. Marco Davila discuss practical strategies for bridging therapy in relapsed/refractory multiple myeloma (RRMM) as patients transition to CAR T-cell therapy. Dr. Davila explains that bridging approaches should be individualized based on disease burden, pace of progression, and treatment timing, highlighting ongoing differences in clinical practice regarding when to collect cells and initiate therapy. He describes the distinction between holding therapy for patients with lower disease burden and bridging therapy for those requiring disease control before infusion. Emphasizing that the primary objective is to safely maintain disease stability rather than achieve a deep response, Dr. Davila advocates for using the least intensive effective therapy to minimize treatment-related toxicity and preserve eligibility for CAR T-cell therapy. Dr. Richter reinforces this principle, cautioning against excessive bridging treatment that may delay or prevent definitive cellular therapy. Together, they underscore that carefully tailored bridging strategies are essential for successfully transitioning appropriate patients to CAR T-cell therapy while optimizing clinical outcomes in RRMM.