Amrita Krishnan, MD

The panelist discusses how for managing patients with R/R multiple myeloma, community clinicians should focus on personalized treatment approaches, incorporating novel therapies such as CAR T-cell therapy while carefully monitoring for and managing toxicities through established protocols. Key considerations include implementing systematic toxicity management strategies, maintaining long-term patient monitoring, and staying informed about emerging therapeutic options. The field is evolving with promising novel agents and combination approaches being investigated, particularly for patients who progress after initial treatments.

The panelist discusses how real-world evidence for CAR T in relapsed/refractory multiple myeloma shows promising efficacy but with some differences from clinical trials. Ide-cel demonstrates effectiveness in patients with prior BCMA exposure, though responses may be impacted. Compared with standard of care (SOC), both ide-cel and cilta-cel show superior outcomes in terms of response rates and progression-free survival, though long-term data are still emerging in real-world settings.

The panelist discusses how the KarMMa-3 trial data demonstrated the superior efficacy of ide-cel vs standard regimens in triple-class exposed R/R MM, with a median progression-free survival of 13.3 vs 4.4 months and an overall response rate of 71% vs 42%. The favorable safety profile and significant survival benefit support ide-cel as a preferred option for third-line and greater treatment, particularly in patients with good performance status who can tolerate bridging therapy.

The panelist discusses how the treatment landscape for early-stage relapsed/refractory multiple myeloma (R/R MM) has evolved significantly with CAR T-cell therapies (idecabtagene vicleucel, ciltacabtagene autoleucel [ide-cel, cilta-cel]) and novel drug combinations. Treatment selection now considers prior therapies, patient characteristics, and response duration. For third-line chimeric antigen receptor (CAR) T after no prior CAR T use, cilta-cel shows favorable efficacy data with deeper, more durable responses than ide-cel, though both are viable options.

The panelist discusses how the patient had triplet therapy 6 years ago, which was the standard for myeloma treatment at the time. Since then, the patient has had a biochemical relapse, renal insufficiency, and moderate anemia, so he needs therapy but not immediate therapy.