Optimizing selection of bridging therapies prior to CAR T-cell therapy for MM

Clinical guidance from an expert roundtable on the selection of bridging therapy prior to chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma (MM) was recently published by Ailawadhi et al. in Clinical Lymphoma, Myeloma & Leukemia. The review provides practical guidance for optimizing bridging therapy to maintain CAR-T eligibility, reduce tumor burden, and support favorable post-infusion outcomes across patient populations.

Key data: Bridging therapy should be individualized based on disease burden, prior treatment exposure, and patient-specific factors, with preference for agents to which the patient is not refractory. Rate of progression should also be considered; patients with aggressive or high-tumor burden disease may require more intensive therapy. The least intensive regimen is recommended, with triplet regimens often appropriate for a lower tumor burden and quadruplet regimens considered for a higher tumor burden. Logistical factors including anticipated manufacturing time and proximity to a treatment center may also influence selection.

Key learning: Optimal bridging prior to CAR T-cell therapy requires an individualized approach based on clinical and logistical factors, including disease burden, rate of progression, and patient-specific factors.