How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?

The role of RT in MM is palliative in nature, and the focus should be on symptomatic improvement while minimizing marrow toxicity.

Rad Oncs, as a whole, should not generally be using solid tumor palliative doses (such as 3 Gy x 10) routinely in MM as that ablates the marrow in that area without hope ...

It depends on the patient. Those patients with pancytopenia related to significant prior therapy are at higher risk of hematologic toxicity from radiation, and this is generally radiation dose-dependent.

This needs to be balanced by the likelihood that the patient will respond to systemic therapy, e....