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News
CAR T-cell therapy is increasingly being used earlier in multiple myeloma treatment, but deciding when to use it versus bispecific antibodies is getting more complex. Expert Omar Castaneda Puglianini, MD, breaks down how patient factors, disease characteristics, and access barriers all shape treatment decisions. A major gap remains: only a small fraction of myeloma patients are ever referred to centers offering CAR T-cell therapy.
CAR T-cell therapies like cilta-cel (Carvykti) and ide-cel (Abecma) are now approved for earlier lines of myeloma treatment — as early as second line — and that's changing how oncologists think about sequencing. According to Dr. Omar Castaneda Puglianini of Moffitt Cancer Center, more than half of his CAR T referrals now come from patients in early relapse, often after progressing on maintenance lenalidomide post-transplant.
But with bispecific antibodies also moving into the second-line space, the big question is: who gets what, and when? The International Myeloma Working Group recommends CAR T-cell therapy before bispecifics when both are available, partly because prior T-cell–redirecting therapy can reduce CAR T efficacy down the line. Patient age, frailty, tumor burden, caregiver support, and geography all factor into the decision.
Key Takeaways:
Why it matters: As the myeloma treatment landscape grows more crowded with powerful options, getting the sequencing right — and ensuring patients can actually access these therapies — will be critical to maximizing long-term survival outcomes.
