Multidisciplinary Approaches in Coordinating Care for CAR T Therapy and Patients With Myeloma
Panelists discuss how multidisciplinary care coordination for chimeric antigen receptor (CAR) T-cell therapy involves registered nurses serving as support persons and liaisons between academic centers and community oncologists, with streamlined communication through direct cell phone access, telehealth consultations to assess candidacy, and coordinated logistics for pretreatment testing, including PET scans, bone marrow biopsies, brain MRIs, and lumbar punctures, while emphasizing that CAR T approval has expanded from fourth-line treatment in 2022 to second-line therapy in 2024, allowing for faster patient access through insurance approval and outpatient T-cell collection processes.
The monitoring protocol for patients with multiple myeloma in remission involves comprehensive surveillance every 4 to 6 weeks through myeloma labs, including light chains and serum protein electrophoresis to track M spike levels. Annual assessments include PET scans for whole-body imaging and bone marrow biopsies, which, although sometimes burdensome for patients, are crucial for early detection of disease progression before severe symptoms develop. This systematic monitoring approach enabled early identification of the patient’s relapse through rising l light chain levels and bone marrow biopsy confirmation.
The multidisciplinary care team approach is essential for managing patients with multiple myeloma, with registered nurses serving as primary support coordinators who facilitate communication between various physicians and specialists. The care coordinator works closely with community oncologists and academic center physicians, maintaining open communication channels to ensure timely referrals when patients need advanced therapies like CAR T-cell therapy. A significant advancement occurred in 2024 when the FDA approved CAR T therapy for second-line treatment rather than requiring patients to wait until fourth-line therapy, dramatically improving access to this innovative treatment option for eligible patients.
The CAR T therapy process involves several preparatory steps once a patient is deemed eligible and insurance approval is obtained through FDA approval and National Comprehensive Cancer Network guideline coverage, including Medicare. Pretreatment testing includes confirming disease progression through myeloma labs, PET scans, and bone marrow biopsies, along with CAR T–specific assessments such as brain MRI, lumbar punctures, and echocardiograms to ensure no disease in cerebrospinal fluid. The treatment workflow has evolved to allow T-cell collection first, followed by additional testing as needed, providing more flexibility in patient management. The actual T-cell collection occurs through an outpatient apheresis process similar to dialysis, where blood is processed through a machine to separate T cells, which are then sent to specialized facilities for genetic engineering before reinfusion.
