Multiple Myeloma Experts Highlight Real-World Safety and Care Coordination Following CAR T-Cell Therapy
Key Points
- Although cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) remain important acute toxicities of chimeric antigen receptor (CAR) T-cell therapy, they occur less frequently and are more effectively managed than in earlier clinical experience.
- Disease burden at the time of CAR T infusion is a key determinant of toxicity risk, with lower tumor burden associated with reduced severity of both CRS and neurotoxicity.
- Coordinated care between academic centers and community oncologists is crucial for the management of chronic toxicities, including prolonged cytopenias, infections, and rare late neurologic effects.
In a recent Clinical Insights discussion, coinciding with the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, Oncology Brothers podcast cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, welcomed 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.
The roundtable discussion focused on evolving approaches to safety management and real-world integration of CAR T-cell therapy in multiple myeloma. They examined acute and chronic toxicities and the importance of coordinated care between treatment centers and community practices.
Compared with earlier CAR T use, acute toxicities, such as CRS and ICANS, occur less often and are more effectively managed.
The expert panelists emphasized that disease burden at the time of infusion is a key factor in toxicity risk, with lower tumor burden correlating with reduced incidence and severity of CRS and neurotoxicity. Many centers are refining inpatient-outpatient hybrid models, including outpatient lymphodepletion followed by brief observation periods before admission. Despite this progress, these toxicities remain clinically meaningful and require structured monitoring and ongoing education for both providers and patients.
The discussion then shifted to chronic toxicities, which are increasingly managed in collaboration with community oncologists. Prolonged cytopenias were highlighted as a common post-treatment issue, often requiring 1 to 3 months for recovery. Infection prevention with standard prophylaxis including antiviral therapy and Pneumocystis jirovecii pneumonia prophylaxis is also a priority. Some centers also monitor cytomegalovirus reactivation because of the increased risk observed after B-cell maturation antigen (BCMA)-targeted therapies. Intravenous immunoglobulin replacement is commonly used for hypogammaglobulinemia.
The experts also shared that infection risk remains highest in the first 6 months after therapy. Neurologic late effects, including rare cranial nerve palsies or Parkinsonism-like symptoms, are uncommon but important to recognize early. They explained that many cases improve over days to weeks with supportive care or corticosteroids.
Overall, close collaboration between academic centers and community physicians for timely evaluation is crucial in the real-world management of these toxicities.