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Opinion|Videos|February 14, 2025

Applying Evidence to Clinical Practice: 63-Year-Old Patient With R/R MM Post Dara-VRd Induction Scenario

Author(s)Saad Z. Usmani, MD, MBA, FACP, Carlyn Rose Tan, MD , Sham Mailankody, MBBS

Panelists discuss how managing a 68-year-old patient with newly diagnosed multiple myeloma (MM) with suboptimal response to Dara-VRd (daratumumab plus bortezomib, lenalidomide, and dexamethasone) requires careful consideration of timing for CAR T referral, product selection, and bridging strategies, while balancing the patient’s preference against standard transplant options in the context of non-high-risk disease.

Episodes in this series

4 experts are featured in this series.

EP. 1 Highlighted Data Review of CAR-T in Early R/R MM

4 experts are featured in this series.

EP. 2 Expert Insights: Distinguishing between CARTITUDE-4 vs. KarMMa-3 Trials

4 experts are featured in this series.

EP. 3 CAR-T in R/R MM: Patient Selection & Treatment Sequencing

4 experts are featured in this series.

EP. 4 CAR-T in Earlier Lines of MM Treatment: Patient Eligibility - Considerations between Ide-cel vs. Cilta-cel

4 experts are featured in this series.

EP. 5 MSKCC Insights: CAR T Referral Process

4 experts are featured in this series.

EP. 6 Overview of the CAR T-Cell Therapy Process: Apheresis, Manufacturing, Potential Bridging Therapies, Lymphodepletion, and Infusion

4 experts are featured in this series.

EP. 7 Collaboration With Community Colleagues: Comanagement and Transitions of Care

4 experts are featured in this series.

EP. 8 CAR T Referral Process: Challenges Seen and How They Can Be Addressed

4 experts are featured in this series.

EP. 9 MSKCC Experiences: Successful CAR T Collaborations With Community and International Providers

4 experts are featured in this series.

EP. 10 CAR-T Clinical Trials: Potentially Moving CAR T Into Earlier Lines of MM Treatment

4 experts are featured in this series.

EP. 11 Applying Evidence to Clinical Practice: 63-Year-Old Patient With R/R MM Post Dara-VRd Induction Scenario

4 experts are featured in this series.

EP. 12 CAR T in R/R MM: Key Takeaways and Pearls

Video content above is prompted by the following:

A 68-year-old man with R-ISS II IgG Kappa MM without any high-risk cytogenetic abnormalities diagnosed in June 2024; bone marrow showing 70% abnormal plasma cells, M-spike 4.8, no bone lesions, anemia present. Patient started on Dara-VRd induction by local oncologist, restaging BMBx after 4 cycles showing 60% abnormal plasma cells. Referred to Memorial Sloan Kettering for consideration of salvage treatment +/– autologous stem cell transplantation (ASCT) for refractory disease. After a long discussion with bone marrow transplant team, patient and daughter declined ASCT and requested CAR T referral.

What is the right time for CAR T referral?
- High-risk considerations
- Bridging
- CAR T product selection
- Referral process/transition back to community

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Michelle L. Taylor, ANP-BC; Emely Alfaro, DNP, RN, CNS, OCN; Paige Griffith, CRNP; Beth Sandy, MSN, CRNP, FAPO

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