To characterize current practice patterns, rationales for regimen selection, and perceived risks/benefits of bridging therapy prior to CAR-T for multiple myeloma (MM), highlighting its critical role in patient management.
Key Findings:
Bridging therapy is common, with over 85% of patients receiving it, primarily using proteasome inhibitors and immunomodulatory drugs.
Most centers report limited standardization in bridging protocols, with 40% indicating 'not standardized at all'.
The typical bridging duration is 1-2 months, with rapid initiation post-apheresis.
Regimen selection is primarily influenced by prior therapy and disease burden, with less emphasis on cytogenetic risk.
Monitoring during bridging relies heavily on serum markers and imaging, with decision-making based on targeted serum marker reductions.
Interpretation:
The findings highlight significant variability in bridging practices for CAR-T therapy in MM, emphasizing the need for standardized protocols and evidence-based guidelines to improve patient outcomes.
Limitations:
The survey reflects practices from a limited number of countries and centers, which may not be representative of global practices.
Responses may be influenced by individual center experiences and access to therapies, particularly bispecific antibodies, potentially introducing bias.
Conclusion:
There is a pressing need for consensus-building and practice-informing evidence to optimize bridging strategies prior to CAR-T therapy in multiple myeloma, addressing the identified gaps in current practices.
by Nico Gagelmann, Maximilian Merz, Laurien G. A. Baaij, Linda Koster, Jorinde D. Hoogenboom, Joanna Drozd-Sokolowska, Kavita Raj, Jürgen Kuball, Patrick J. Hayden, Florent Malard, Laurent Garderet, Annalisa Ruggeri, Donal McLornan
