CAR-T Referral Process: Insights from UCSF

A panel of experts discuss CAR T therapy in earlier lines of treatment within the R/R multiple myeloma treatment paradigm.

Panelists discuss how, when considering earlier lines of CAR T-cell therapy for relapsed/refractory multiple myeloma, key institutional factors include patient fitness/age, cytogenetic risk status, prior therapy response duration, and BCMA expression levels. Manufacturing timelines, financial considerations, and center-specific outcomes data also influence timing decisions. For patients receiving early-line CAR T therapy, subsequent treatment options typically focus on novel agent combinations or clinical trials exploring additional cellular therapies, with choices guided by response duration to CAR T and the patient’s individual disease characteristics and treatment goals.

Panelists discuss how, for second-line treatment of relapsed/refractory multiple myeloma (R/R MM), patients suitable for CAR T-cell (cilta-cel vs ide-cel) therapy typically have a poor prognosis with limited response to prior therapies. Institutional guidelines focus on factors such as prior lines of therapy, organ function, and cytogenetics. Non-medical factors, such as geographic access and financial constraints, also influence CAR T-cell therapy referral eligibility.

Panelists discuss how the typical CAR T-cell therapy referral process begins with community physicians contacting the treatment center. The patient undergoes a thorough evaluation, including medical history, eligibility criteria, and pretreatment assessments before final selection for therapy.

Panelists discuss how CAR T-cell therapy involves engineering a patient’s T cells to target cancer cells. The process includes cell collection, genetic modification, expansion, and reinfusion and streamlines the process with integrated workflows. Bridging therapy is provided in-house to treat patients awaiting CAR-T infusion.

Panelists discuss their institution’s approach to co-management and co-monitoring of (chimeric antigen receptor (CAR) -T patients, strategies to facilitate seamless transitions of care between academic centers and community practices, common challenges in the CAR -T referral process and solutions, and advice for community physicians on the timing and preparation for patient referrals.

Panelists discuss successful collaborations between academic centers and community practices in the context of (chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma, key lessons learned in integrating CAR T therapy into the treatment landscape, and future plans for expanding CAR T therapy’s role in earlier lines of multiple myeloma treatment.

Panelists discuss a clinical scenario involving a 56-year-old male man with myeloma and del 17p deletion, treated with RVD induction, auto transplant, and lenalidomide maintenance, who relapsed after 2 years and is now referred to discuss chimeric antigen receptor (CAR) CAR-T versus vs standard therapy, sharing key takeaways and pearls from the case.