Role of CAR T in Earlier Lines for R/R MM

EP: 1.Late-Line R/R: Treatment Landscape

EP: 2.Outcomes and Factors for Consideration When Choosing Between CAR T Therapies

EP: 3.Role of Talquetamab as Bridging Therapy for CAR T-Cell Therapy

EP: 4.Optimal Sequencing Strategies for CAR T and Bispecifics in R/R MM

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EP: 5.Role of CAR T in Earlier Lines for R/R MM

EP: 6.Non-ICANS and Delayed Neurotoxicity With CAR T: Risk Factors and Ways to Prevent

Incorporating CAR T-cell therapy in earlier lines of treatment for multiple myeloma is becoming increasingly supported by clinical data and expert consensus. With one product approved for second-line and another for third-line use, clinicians are now considering CAR T as a viable option for patients progressing after initial treatment, even those who are ineligible for transplant. The decision often hinges on clinical features such as functional high-risk disease or early relapse, where the progression-free and overall survival benefits of CAR T clearly outweigh the risks. For these patients, early referral and discussion of CAR T should be prioritized.

However, not all patients are immediate candidates. Factors such as access to care, caregiver availability, distance from treatment centers, and personal preference significantly influence real-world decision-making. Safety considerations, particularly the potential for delayed neurotoxicity even in patients with low disease burden, require careful risk-benefit analysis. In standard-risk patients who have experienced long remissions after first-line therapy, clinicians may opt for a second-line regimen before considering CAR T, especially in the absence of clinical high-risk indicators. This approach preserves CAR T as a potent option at a later relapse without compromising immediate outcomes.

The key message is that CAR T therapy should not be delayed until late in the treatment journey. By the third line, many patients are already triple-class exposed and may become functionally ineligible due to disease progression or cumulative toxicity. Early referral—even before second relapse—allows patients to be evaluated while still fit enough for therapy. As treatment paradigms evolve to include optimal sequencing and personalized strategies, integrating CAR T earlier for appropriate patients ensures that more individuals can benefit from its durable responses, especially before comorbidities or disease biology limit therapeutic options.