For a patient with triple-class-refractory myeloma and cytopenias who has been collected for CAR-T, would you choose aggressive chemotherapy or a bispecific antibody for bridging?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • University of Washington • NCI-CCC Myeloma Tumor Board Question • Multiple Myeloma

This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispecifics (either BCMA or GPRC5D) have theoretical risks and unknown efficacy.

Answer from: Medical Oncologist at Academic Institution

The median time to response for bispecific antibodies targeting BCMA and GPRC5d is over a month. Usually, when we employ bridging therapy we want a much quicker response. Resistance likely doesn’t play a role here because of the short time that they are being used. I prefer to avoid VD-pa...

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Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
These are both excellent responses - thank you, @B...

Answer from: Medical Oncologist at Academic Institution

It is a common question and also remains a challenging situation in the real world! Many key points need to be addressed here regarding the disease (assuming pt is fit since he is undergoing CAR-T): If the disease is aggressive with a high burden (I will be aggressive with using VDPACE or V...

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