Relapsed/Refractory Multiple Myeloma: Distinguishing CAR T Eligibility From Transplant Eligibility

Dr. Joshua Richter and Dr. Marco Davila present a case of a patient with relapsed/refractory multiple myeloma (RRMM) experiencing first relapse after initial therapy and discuss whether patients considered ineligible for autologous stem cell transplantation may still be candidates for CAR T-cell therapy. Dr. Davila emphasizes that transplant eligibility and CAR T-cell eligibility are distinct concepts, noting that CAR T eligibility is primarily determined by the approved indication and prior lines of therapy rather than traditional transplant criteria such as age or baseline organ function. Instead of using these factors to exclude patients, he explains that they should inform risk assessment and supportive care planning, including decisions regarding inpatient versus outpatient treatment and toxicity monitoring. The discussion highlights the importance of evaluating each patient individually, recognizing that many patients who are not transplant candidates may still safely benefit from CAR T-cell therapy, particularly given the favorable safety profile observed with BCMA-directed CAR T-cell therapies in RRMM.