Treatment Sequencing in Early Relapsed/Refractory Multiple Myeloma

Dr. Joshua Richter introduces the discussion with Dr. Doris Hansen, outlining the evolving role of CAR T-cell therapy in early relapsed/refractory multiple myeloma, with a focus on treatment sequencing, patient selection, bridging therapy, toxicity management, and emerging cellular therapies. Dr. Hansen discusses how the expanding availability of BCMA-directed CAR T-cell therapies and bispecific antibodies has increased the number of treatment options at first relapse and made individualized treatment selection increasingly important. She highlights disease-related factors such as the pace of relapse, high-risk cytogenetic features, and extramedullary disease, along with patient-specific considerations including age, comorbidities, frailty, caregiver support, and distance from a cellular therapy center. Dr. Hansen notes that evidence guiding sequencing in earlier lines continues to evolve but explains that, at her institution, younger and fit patients with appropriate access will generally be considered for CAR T-cell therapy first. She emphasizes that treatment decisions must account for both clinical and logistical factors.