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Case Challenge: A 78-Year-Old Patient With High-Risk Multiple Myeloma and Early Relapse After First-line Therapy

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This activity is available for 0.50 CME/CE credit(s).

Released: September 30, 2026

Expiration: March 29, 2027

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Step 1 of 5

1 Pre Assessment 2 Challenge 3 Post Assessment 4 Evaluation 5 Credit

Despite the evolving evidence supporting earlier use of BCMA-directed CAR T-cell therapy in multiple myeloma, practical gaps remain in patient selection, referral timing, bridging therapy, treatment sequencing, and shared-care coordination. This interactive case challenge follows an older, fit patient with high-risk multiple myeloma who experiences an early relapse and is being considered for BCMA-directed CAR T-cell therapy. Through expert-guided branching decisions, you will evaluate CAR T-cell eligibility, select an appropriate bridging strategy, consider sequencing with bispecific antibodies and other therapies, and recognize and manage delayed CAR T-cell therapy–associated neurotoxicity.

Saurabh Zanwar
Saurabh Zanwar, MD
RR MM CAR T Case

Pre Assessment

Assess your current knowledge and clinical approach before beginning your Case Challenge.
Begin Your Case Challenge
1.

How many people with multiple myeloma do you provide care for in a typical month?

2.

For those who practice in academic or community settings, please indicate your practice setting:

3.

A 36-year-old woman was diagnosed with kappa free light chain MM in 2024​: International Staging System stage III; cytogenetics/fluorescence in situ hybridization: presence of del(17p); t(4:14) and 1q amplification​. She started daratumumab plus bortezomib/lenalidomide/dexamethasone (D-VRd) as first-line therapy and underwent autologous stem cell transplant with bortezomib plus lenalidomide as maintenance therapy​. However, she experienced symptomatic disease progression 7 months later.

Based on current indications, which CAR T-cell therapy would this patient be eligible for, if any?

4.

A 62-year-old patient with relapsed/refractory (R/R) MM is referred for BCMA-directed CAR T-cell therapy after 4 prior lines of therapy. The patient is penta-drug refractory (including to a PI, IMiD, and anti-CD38 monoclonal antibody) and has a high disease burden with rapidly progressive symptoms. Manufacturing is expected to take approximately 4-5 weeks.​​

Which of the following would you recommend as the most appropriate choice for bridging therapy for this patient?

5.

Which combination of findings is most characteristic of delayed parkinsonian-like neurotoxicity reported after CAR T-cell therapy?

Begin Your Case Challenge