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

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

CAR T-Cell Therapy in Multiple Myeloma

Multiple myeloma (MM) is a hematologic malignancy recognized through the uncontrolled proliferation of plasma cells within the bone marrow. While 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. According to prior data, patients who are eligible for CAR T-cell therapy have often exhausted multiple prior lines of treatment, leading to limited remaining therapeutic options.³

CAR T-cell therapy is characterized as 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 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 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 Therapy

Promising outcomes when CAR T-cell therapy is administered earlier in treatment sequencing have been demonstrated in emerging clinical trials. In the 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 gathered demonstrated a significant improvement in progression-free survival compared with standard-of-care regimens. Findings from the KarMMa-3 trial (NCT03651128) similarly displayed improved outcomes with ide-cel in triple-class–exposed relapsed and refractory MM.^2,6

This data is significant clinically due to the earlier use of CAR T 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 therapy progresses into earlier lines, the treatment paradigms for MM may continue shifting away 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 take the position of essential members of the multidisciplinary CAR T-cell therapy team. One of the most crucial responsibilities for pharmacists is monitoring and managing toxicities associated with CAR T therapy, which include 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 have a heavy involvement in infection prevention and supportive care management. Prolonged cytopenias, hypogammaglobulinemia, and increased susceptibility to bacterial, viral, and fungal infections are potential adverse effects in patients receiving CAR T therapy.⁷ Antimicrobial prophylaxis, vaccination recommendations, immunoglobulin replacement considerations, and medication reconciliation throughout treatment are all regimens pharmacists may be well-positioned to assist in.⁷

Moving CAR T therapy earlier in treatment sequencing may also increase referrals and patient volume at both academic and community oncology centers. Therefore, pharmacists may run into a developing necessity for patient counseling in regard to treatment expectations, bridging therapy, adverse effects monitoring, and transitions between inpatient and outpatient care settings.

With the ongoing evolution of the MM treatment landscape, the role of the pharmacists remains crucial in supporting safe CAR T-cell therapy implementation 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 Enl J Med. 2023;389(4):335-347. doi.org/10.1056/nejmoa2303379

3. American Cancer Society. What is multiple myeloma? Updated February 28, 2025. Accessed May 15th, 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.org/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