Cell Therapy / Cell Therapy in MM at ASCO 2026 06/05/2026

CAR T in Myeloma: Earlier Use and Sequencing Insights from ASCO 2026

Binod Dhakal, MD OncUpdates, healthcare professional, oncology specialist, cancer research, medical news, cancer treatment updates, oncology news platform, cutting-edge cancer therapies, expert cancer insights, cancer care advancements. Surbhi Sidana, MD Smiling man with beard wearing a white shirt, professional headshot, suitable for oncology or cancer research content, emphasizing healthcare and medical expertise. Rahul Gosain, MD, MBA Oncologist smiling in white coat, highlighting cancer research and treatment expertise, with a bow tie, in a bright medical setting. Rohit Gosain, MD

Key Points

  • Chimeric antigen receptor (CAR) T-cell therapy has demonstrated significant improvements in progression-free survival (PFS) in earlier-line multiple myeloma, supporting its use beyond heavily pretreated populations.
  • Real-world data show that CAR T can be safely and effectively administered in broader patient populations in both academic and community settings.
  • Although adverse events, such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), are serious, they have declined following improved monitoring and earlier intervention.
  • Sequencing strategies continue to evolve, with current data favoring the use of CAR T-cell therapy before bispecific antibodies.

The cohosts of the Oncology Brothers podcast, Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, hosted a panel discussion on CAR T-cell therapy in multiple myeloma coinciding with the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting. They were joined by three hematology experts: Ajai Chari, MD, of University of California, San Francisco Health; Binod Dhakal, MD, of the Medical College of Wisconsin; and Surbhi Sidana, MD, of Stanford University.

CAR T-cell therapy has rapidly reshaped the treatment landscape for multiple myeloma, especially for patients who have relapsed or refractory disease. Recent clinical trial data and real-world evidence highlight the promise of this cellular therapy in both the community and academic settings.

CARTITUDE Trials

Ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)–directed CAR T-cell therapy, initially received approval based on the CARTITUDE-1 trial in heavily pretreated patients, demonstrating deep and durable responses. Subsequent data from CARTITUDE-4 supported cilta-cel’s earlier use, leading to its approval in the second-line setting. In CARTITUDE-4, cilta-cel significantly improved PFS, with an approximately 75% risk reduction compared with standard-of-care regimens, and demonstrated an overall survival (OS) benefit. These findings established CAR T-cell therapy as a highly effective option earlier in the disease course.

A key insight from CARTITUDE-4 and subsequent analyses focuses on disease control prior to CAR T infusion, Dr. Chari said. Patients who progressed during bridging therapy or had suboptimal disease control before infusion had inferior outcomes, reinforcing the concept that CAR T is best deployed as a consolidation strategy rather than as salvage therapy for uncontrolled disease.

Real-World Evidence

Real-world data further support CAR T-cell therapy in patients with multiple myeloma. Analyses including patients treated outside of clinical trials — many of whom would not have met trial eligibility criteria because of comorbidities — demonstrate comparable efficacy and safety outcomes, Dr. Sidana said. Approximately two-thirds of real-world patients would have been trial-ineligible, yet outcomes remained consistent with pivotal studies. The panelists agreed that this provides reassurance that CAR T can be safely and effectively administered in broader patient populations encountered in routine practice.

Updates presented at ASCO 2026 showed that outcomes appear consistent across standard- and high-risk cytogenetic groups, expanding CAR T’s applicability beyond previously perceived high-risk subsets. Furthermore, the role of bridging therapy has become increasingly defined. Patients achieving at least a partial response prior to infusion have improved efficacy outcomes and reduced toxicity. However, those with progressive disease during bridging are at higher risk of both inferior disease control and treatment-related adverse events, such as immune effector cell–associated enterocolitis that has been observed in real-world settings, Dr. Dhakal said.

CAR T Toxicity Management

Acute toxicities, including CRS and ICANS, are better understood and more effectively managed than in previous years. With earlier intervention, improved monitoring, and reduced disease burden at infusion, rates of high-grade CRS and ICANS have declined, Dr. Dhakal said. Most CRS events are low grade, and severe neurotoxicity is increasingly uncommon.

Delayed and chronic toxicities are important for community oncologists to understand because they often take over care following CAR T-cell therapy. Dr. Chari noted that cytopenias may persist for 1 to 3 months and may require growth factor support and infection prophylaxis. He further explained that antiviral (eg, herpes simplex virus/varicella-zoster virus) and Pneumocystis jirovecii pneumonia prophylaxis are standard because immune recovery may take up to 6 months. Intravenous immunoglobulin replacement is also commonly used.

Because infectious complications are the most common cause of nonrelapse mortality, particularly within the first year following CAR T, the panelists stressed early evaluation of even minor infectious symptoms. Although rare, notable delayed neurologic toxicities, including cranial nerve palsies and Parkinsonian features, require close monitoring and, in some cases, collaboration with specialized centers.

CAR T vs BCMA-Directed Bispecific Antibodies

A key clinical decision point in the current treatment landscape is the choice between CAR T-cell therapy and BCMA-directed bispecific antibodies in the relapsed setting. Both approaches demonstrate PFS and OS benefits, but they differ in administration, toxicity profiles, and patient experience, Dr. Chari explained. CAR T offers a finite treatment course with the potential for prolonged remission without ongoing therapy, whereas bispecific antibodies require continuous therapy and carry risks associated with chronic immune activation. Patient-specific factors, such as disease progression, logistical considerations, caregiver support, and patient preference, are central to shared decision-making, Dr. Chari stressed.

Emerging data from ASCO 2026 also suggest that sequencing may affect outcomes. Current evidence, largely from later-line settings, supports the use of CAR T prior to bispecific antibodies, potentially because of preserved T-cell fitness, Dr. Sidana said.

Future Implications

The panelists noted that strong collaboration between community oncologists and tertiary care centers is essential. Early referral at first relapse allows for timely evaluation, apheresis, and treatment planning, while avoiding therapies that may compromise CAR T eligibility, such as prior BCMA-directed agents.

The panelists agreed that CAR T-cell therapy has become a key component in the management of multiple myeloma. Outcomes depend on patient selection, effective disease control prior to infusion, proactive toxicity management, and coordination between academic and community practices.