Addressing the Role of CAR T-Cell Therapy in Multiple Myeloma

Deepu Madduri, MD, assistant professor of medicine, hematology and medical oncology and assistant professor of urology at Mount Sinai, discusses how chimeric antigen receptor (CAR) T-cell therapy is used for patients with multiple myeloma.

CAR T-cell therapy, bispecific agents, and antibody-drug conjugates are the current treatment options available for the relapsed/refractory multiple myeloma population. However, CAR T-cell therapy is typically reserved for patients who are younger and more fit, who do not have rapidly progressing disease. The bispecific agents are used mostly in elderly patients with many comorbidities and cannot handle cytokine release syndrome. Patients with rapid progression cannot wait the 4 to 5 weeks it takes to manufacture their cells for CAR-T cell therapy, says Madduri.

There are different roles for CAR T-cell therapy compared with bispecific therapy. Madduri feels it is important to keep in mind that multiple myeloma is an incurable disease for these patients, so the field does need all these therapies to treat at different points. The question is how to sequence them so patients achieve the best progression-free survival they can.