Relapsed/Refractory Multiple Myeloma: Individualizing CAR T-Cell Therapy Timing

Dr. Joshua Richter and Dr. Marco Davila discuss how clinicians determine the optimal timing for CAR T-cell therapy in relapsed/refractory multiple myeloma (RRMM), emphasizing that treatment decisions should be individualized rather than based solely on line of therapy. Drawing on long-term follow-up data from CARTITUDE studies, Dr. Richter highlights the potential for durable remissions and asks how these findings influence real-world practice. Dr. Davila explains that every patient experiencing relapse should have CAR T-cell therapy considered early in the treatment discussion, with decisions guided by disease biology, pace of relapse, cytogenetic risk, and patient-specific factors. The conversation also explores how high-risk features and rapidly progressive disease may favor earlier use of CAR T-cell therapy, whereas patients with slower biochemical relapse or logistical challenges may be appropriate candidates for alternative approaches, including bispecific antibodies. Together, the faculty emphasizes the importance of shared decision-making and individualized treatment sequencing to maximize long-term outcomes in RRMM.