While using bridging therapy prior to CAR-T cells in myeloma, if possible, do you target a certain response prior to proceeding with cell infusion?

While CAR-T cell therapy was, of course, first studied and shown to be highly effective in heavily pretreated patients with active disease, experience and newer data show the following themes:

1. CAR-T cell therapy in earlier lines of therapy appears to lead to more durable responses.
2. Lower disease burden going into CAR-T is associated with better efficacy and lower toxicity.
3. Bridging therapy may help to mitigate toxicity, especially high-grade ones.

So my preference has been to take patients to CAR-T early during biochemical relapse. When that isn’t possible, I use holding/bridging therapy to obtain a response. Sometimes, it is more prudent to use holding therapy for a cycle to gain a response, pause for T cell harvesting, and then resume t...

From the moment that you choose to move forward with FDA-approved CARVYKTI, you'll need to schedule immune cell collection and lymphodepletion. At my center, it takes approximately 2-4 weeks to get a collection spot during which staff works on insurance submission & approval as well as safety work-up. Hence, for me, there is often a month until immune cell collection, and then 4-6 weeks from collection to CAR-T infusion. Regimens used during these periods I name "pre" bridging therapy before collection, and then bridging therapy between collection and infusion.

Based on data generated from KARMMA, we try not to use alkylators as part of pre-bridging therapy. Based on data from the immune cell consortium, we try to achieve serum-free light c...