What Pharmacists Should Know About Earlier CAR T Therapy in Multiple Myeloma

The treatment landscape for relapsed or refractory multiple myeloma is rapidly evolving, particularly with the emergence of chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapy has provided meaningful responses for patients with historically limited therapeutic options. Emerging clinical data and regulatory expansions are currently advancing CAR T-cell therapies into earlier lines of treatment, potentially reshaping long-term disease management and supportive care strategies. With the expansion of CAR T-cell therapy, the pharmacist’s role is increasingly necessary for toxicity monitoring, medication management, patient education, and care coordination.^1,2

CAR T-Cell Therapy in Multiple Myeloma

Multiple myeloma (MM) is a hematologic malignancy characterized by the uncontrolled proliferation of plasma cells in the bone marrow. Although there have been advances in the MM treatment regimen, such as proteasome inhibitors, immunomodulatory agents, monoclonal antibodies, and bispecific therapies, many patients ultimately relapse and develop treatment-resistant disease. Data show that patients eligible for CAR T-cell therapy have often exhausted multiple lines of treatment, leaving limited therapeutic options.³

CAR T-cell therapy is a personalized immunotherapy approach in which a patient’s T cells are collected and genetically engineered to recognize specific antigens expressed on malignant plasma cells. In MM, the currently approved CAR T-cell products primarily target B-cell maturation antigen (BCMA), a protein highly expressed on myeloma cells. The engineered T cells are reinfused into the patient, where they identify and destroy malignant cells following modification and expansion.¹

Ciltacabtagene autoleucel (cilta-cel, Carvykti; Janssen Biotech, Inc) and idecabtagene vicleucel (ide-cel, Abecma; Celgene Corporation) are the only currently approved BCMA-directed CAR T-cell therapies that have demonstrated durable responses in heavily pretreated patient populations. These responses have prompted researchers to evaluate these therapies earlier in disease progression.^2,4,5

Emerging Data in Earlier Use of CAR T-Cell Therapy

Promising outcomes have been demonstrated in emerging clinical trials when CAR T-cell therapy is administered earlier in treatment sequencing. In the phase 3 CARTITUDE-4 trial (NCT04181827), the researchers analyzed cilta-cel in patients who received 1 to 3 prior lines of therapy with lenalidomide-refractory MM. The data demonstrated a significant improvement in progression-free survival compared with standard-of-care regimens. Findings from the phase 3 KarMMa-3 trial (NCT03651128) similarly displayed improved outcomes with ide-cel in triple-class–exposed relapsed and refractory MM.^2,6

These data are significant clinically due to the earlier use of CAR T-cell therapy, potentially allowing patients to receive therapy before substantial disease progression, T-cell exhaustion, or declining performance status limits treatment eligibility. Analyses of these data suggest that earlier intervention may improve the quality and function of collected T cells, potentially contributing to more durable responses.^1,2

As CAR T-cell therapy advances into earlier lines of therapy, the treatment paradigms for MM may continue to shift from prolonged continuous therapy toward highly individualized immune-based treatment strategies. This broader implementation also introduces new operational and safety considerations for oncology pharmacists.²

Why This Matters for Pharmacists

As treatment expands into community oncology settings, pharmacists become essential members of the multidisciplinary CAR T-cell therapy team. Pharmacists must monitor and manage toxicities associated with CAR T-cell therapy, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Preventing severe complications is critical and can be achieved through early recognition and intervention.¹

Likewise, pharmacists play a significant role in infection prevention and supportive care management. Prolonged cytopenias, hypogammaglobulinemia, and increased susceptibility to bacterial, viral, and fungal infections are potential adverse effects of CAR T-cell therapy.⁷ Pharmacists are well-positioned to assist with antimicrobial prophylaxis, vaccination recommendations, immunoglobulin replacement considerations, and medication reconciliation throughout a patient’s treatment.⁷

Moving CAR T-cell therapy earlier in treatment sequencing may increase referrals and patient volume at both academic and community oncology centers. Therefore, pharmacists may face a growing need for patient counseling regarding treatment expectations, bridging therapy, monitoring for adverse effects, and transitions between inpatient and outpatient care settings.

With the ongoing evolution of the MM treatment landscape, the role of pharmacists remains crucial in supporting safe implementation of CAR T-cell therapy while optimizing outcomes through education, supportive care, and interdisciplinary collaboration.

REFERENCES

1. Munshi NC, Anderson LD Jr, Shah N, et al. Idecabtagene vicleucel in relapsed and refractory multiple myeloma. N Engl J Med. 2021;384(8):705-716. doi:10.1056/NEJMoa2024850

2. San-Miguel J, Dhakal B, Yong K, et al. Cilta-cel or standard care in lenalidomide-refractory multiple myeloma. N Engl J Med. 2023;389(4):335-347. doi:10.1056/nejmoa2303379

3. American Cancer Society. What is multiple myeloma? Updated February 28, 2025. Accessed May 15, 2026. https://www.cancer.org/cancer/types/multiple-myeloma/about/what-is-multiple-myeloma.html

4. Carvykti. Prescribing information. Accessed May 15th, 2026. https://www.carvyktihcp.com

5. Abecma. Prescribing information. Accessed May 15th, 2026. https://packageinserts.bms.com/pi/pi_abecma.pdf

6. Rodriguez-Otero P, Ailawadhi, S, Arnulf B, et al. Ide-cel or standard regimens in relapsed and refractory multiple myeloma. N Engl J Med. 2023;388(11):1002–1014. doi:10.1056/nejmoa2213614

7. Hill JA, Seo SK. How I prevent infections in patients receiving CD19-targeted chimeric antigen receptor T cells for B-cell malignancies. Blood. 2020;136(8):925-935. doi:10.1182/blood.2019004000