Early Referral and Patient Education: Setting the Stage for CAR T in MM

Video content above is prompted by the following:

Louis Williams, MD, emphasizes the importance of early referral for CAR T evaluation, ideally at or around diagnosis, to ensure access to clinical trials and optimize manufacturing conditions. The attrition rate across therapy lines necessitates proactive planning, with better outcomes observed in younger, less heavily pretreated patients who can produce more immune-fit T-cell products. Academic centers should maintain strong community partnerships and consider changing referral patterns from "transplant-eligible" to broader "consolidation referrals" for all patients with myeloma.

Access to early-line trials such as CARTITUDE-6 and CARTITUDE-10 requires timely referral to participating centers. The analogy to transplant referral patterns is appropriate: Just as transplant discussions begin early regardless of immediate intent, CAR T conversation should start at diagnosis to allow adequate time for patient education and decision-making. This approach ensures patients understand their options and can make informed decisions when treatment becomes necessary.

Peter Voorhees, MD, conducts extensive counseling sessions outside regular clinic hours due to the complexity of CAR T education. Discussions cover CRS, neurologic toxicities including immune effector cell-associated neurotoxicity syndrome and delayed effects such as cranial nerve palsies and parkinsonism, hematologic complications, secondary malignancy risks including myelodysplastic syndromes/acute myeloid leukemia and CAR T lymphomas, and emerging toxicities such as immune effector cell enterocolitis. The education balances realistic risk assessment with efficacy data to enable informed decision-making without creating unnecessary fear.