Sequencing the Available T Cell– Engaging Therapies, and the Role of Bridging/Holding Therapy in RRMM

EP: 1.Exploring the Treatment Options for RRMM

Now Viewing

EP: 2.Sequencing the Available T Cell– Engaging Therapies, and the Role of Bridging/Holding Therapy in RRMM

EP: 3.Exploring T-Cell Fitness Strategies to Optimize Clinical Outcomes in RRMM

EP: 4.Discussing the Treatment Options for RRMM Following Progression After BCMA CAR T Therapy

Physician Summary: Sequencing and Bridging Strategies for T-Cell Engaging Therapies in RRMM

Sequencing CAR T vs Bispecifics
Guidelines from IMWG and ASCO support using CAR T therapy before bispecific antibodies when possible, due to its potential for durable, deep responses. In practice, CAR T is preferred first if patients are eligible and can wait for manufacturing. Bispecifics are used when rapid disease control is needed or CAR T is not feasible.

Bridging vs Holding Therapy

• Bridging therapy: Actively controls disease while awaiting CAR T.

• Holding therapy: Stabilizes disease with minimal immune suppression, used when progression is slower.

Bridging Therapy Options

• Bispecifics (B-cell maturation antigen [BCMA]: teclistamab, elranatamab): Effective but may impair CAR T efficacy targeting the same antigen.

• Bispecifics (GPRC5D: talquetamab): Preferred when bridging to BCMA-directed CAR T to avoid antigen overlap.

• Selinexor-based regimens: Active in refractory disease, synergistic with proteasome inhibitors, and may support CAR T outcomes (BOSTON, STOMP, COSTA analyses).

• Cytotoxic chemo (VD-PACE, DCEP + IMiD): Used for aggressive disease but can impair marrow/T-cell function.

• Radiation (XRT): For localized disease or symptom control.

Key Takeaway: Choose bridging therapy based on disease tempo, prior therapies, and impact on CAR T readiness, prioritizing nonoverlapping targets and immune preservation.