BRIDGE-2M: Consensus recommendations for bridging therapy prior to CAR T-cell therapy in RRMM

Results from the BRIDGE-2M consensus on bridging therapy (BT) selection for patients with relapsed/refractory multiple myeloma (RRMM) awaiting chimeric antigen receptor T-cell (CAR T-cell) therapy were published in Advances in Therapy by Banerjee et al. The consensus was developed through a double-blind, three-round modified Delphi process involving 15 US-based hematologist–oncologists and hematologists who had treated ≥20 patients with MM using CAR-T therapy in the previous 12 months. Ten panelists participated in the final consensus round.

Key data: The key goals of BT are to reduce disease burden prior to CAR T-cell infusion and to support deep and durable responses to subsequent CAR T-cell therapy. Five patient attributes were linked to a specific clinical objective: disease stabilization for older (≥65 years) patients and those with frailty; cytoreduction for aggressive disease; prevention of clinical decline for high disease burden; functional preservation for significant comorbidities; and preservation of end-organ function for poor performance status. Moderate consensus was reached for disease stabilization in patients with frailty, while strong consensus was reached for the other four clinical objectives. The panel also reached strong consensus that talquetamab may be appropriate as BT in selected patients, particularly those with high disease burden and/or aggressive disease. Suggested administration included 1–2 cycles with step-up dosing.

Key learning: The BRIDGE-2M consensus established a framework linking five patient-specific attributes to clinical objectives, providing an approach to inform BT selection prior to CAR T-cell therapy in RRMM.