CAR T-Cell Safety and Supportive Care in Relapsed/Refractory Multiple Myeloma

In this segment, Dr. Peter Voorhees and Dr. Doris Hansen discuss the safety profile and post-treatment management of CAR T-cell therapy in relapsed/refractory multiple myeloma, with emphasis on considerations for community oncologists caring for patients after discharge from the CAR T-cell center. Dr. Hansen reviews early immune-mediated toxicities, including cytokine release syndrome and ICANS, which generally occur within the first week following CAR T-cell infusion and are typically managed at the treating center with tocilizumab and corticosteroids. She then discusses delayed toxicities, including cranial nerve palsy and parkinsonism, which may emerge several weeks after treatment. Dr. Hansen contrasts the reported incidence of parkinsonism in earlier studies with the lower incidence observed in CARTITUDE-4. The discussion also addresses prolonged cytopenias and potential supportive measures, including growth factor support and transfusions. Dr. Hansen emphasizes that infection remains an important consideration after CAR T-cell therapy and reviews prophylactic strategies, including antiviral therapy, antibacterial prophylaxis when neutropenic, PJP prophylaxis, and IVIG, with duration individualized according to infectious history and immune recovery.