Sequencing CAR T-Cell Therapy in Multiple Myeloma

Dr. Joshua Richter discusses the rationale behind prioritizing BCMA-directed CAR T-cell therapy before BCMA-directed bispecific antibodies in eligible patients with multiple myeloma, reflecting current International Myeloma Working Group considerations. He explains how the interval between sequential exposures to BCMA-directed therapies may influence the effectiveness of subsequent treatment and describes the importance of considering the overall treatment sequence when planning therapy. Dr. Richter then raises the question of whether patients should wait for next-generation CAR T-cell therapies rather than receive an available treatment today. Dr. Doris Hansen acknowledges the potential of emerging approaches, including next-generation CAR T-cell platforms, dual-targeted CAR T-cell therapies, trispecific approaches, and in vivo CAR T-cell strategies, while emphasizing that many remain investigational. She stresses the importance of treating the patient based on their current clinical needs rather than delaying effective available therapy in anticipation of future options. Dr. Richter similarly highlights the need to act promptly when disease progression requires treatment while recognizing that individual circumstances may influence the timing of therapy.