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

Case Challenge

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.

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Pharmacists: 0.50 contact hour (0.05 CEUs)

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: September 30, 2026

Expiration: March 29, 2027

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Faculty

Saurabh Zanwar

Saurabh Zanwar, MD

Assistant Professor and Senior Associate Consultant
Division of Hematology
Mayo Clinic
Rochester, Minnesota

Provided by

Provided by Clinical Care Options, LLC dba Decera Clinical Education

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Supporters

This activity is supported by educational grants from Johnson & Johnson and Legend Biotech USA Inc.

Johnson & Johnson

Legend Biotech USA Inc.

Target Audience

This activity is intended for hematologists, oncologists, advanced practice providers, nurses, physician associates, pharmacists, and other healthcare professionals who care for patients with multiple myeloma. 

Program Learning Goal

This activity aims to improve learners’ knowledge, confidence, and competence in integrating CAR T-cell therapies into treatment plans for patients with relapsed/refractory multiple myeloma.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Apply patient selection and eligibility criteria for BCMA-directed CAR-T therapy in MM, including evidence-informed considerations for high-risk disease, older or frail patients, and those with clinically relevant comorbidities 

  • Implement bridging and sequencing strategies across BCMA CAR-T and T-cell–redirecting therapies (including bispecific antibodies), using emerging clinical trial and real-world evidence to optimize timing, target selection, and downstream options 

  • Integrate new and evolving BCMA CAR-T data, including earlier-line use, durability of response, and real-world experience, into practical, patient-specific treatment decisions

  • Recognize, differentiate, and manage CAR-T–associated adverse events, with emphasis on CRS and ICANS, as well as late/atypical neurotoxicities reported with BCMA-directed constructs (eg, Parkinsonian features and cranial nerve palsies), to support timely triage and safe care delivery 

Financial Disclosures

Decera Clinical Education requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose all financial conflicts of interest (COI) they may have with ineligible companies. All relevant COI are thoroughly vetted and mitigated according to Decera Clinical Education policy. Decera Clinical Education is committed to providing its learners with high-quality CME/CE activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The faculty reported the following relevant financial relationships or relationships to products or devices they have with ineligible companies related to the content of this educational activity:

Primary Author

Saurabh Zanwar, MD: speaker (paid to institution): Sanofi.

The planners and content peer reviewers from Decera Clinical Education do not have any relevant financial relationships to disclose, except Kristi K. Orbaugh, MSN, NP, AOCNP, as noted below:

Kristi K. Orbaugh, MSN, NP, AOCNP: speaker: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, DSI, Exelixis, Lilly, Pfizer, Stemline.

Instructions for Credit

Participation in this self-study activity should be completed in approximately 0.5 hours. To successfully complete this activity and receive credit, participants must follow these steps during the period from September 30, 2026, through March 29, 2027:

  1. Login or Sign Up for an account by clicking at the top of this page.
  2. Read the target audience, learning objectives, and faculty disclosures.
  3. View and study the content in its entirety.
  4. Submit answers to the posttest questions and evaluation questions online.

You must receive a test score of at least 65 and respond to all evaluation questions to receive a certificate. After submitting the evaluation, you may access your online certificate by selecting the certificate link on the confirmation page. Records of all CME/CE activities completed can be found on the "My Certificates" page. There are no costs/fees for this activity.

Format

This program has been made available online.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Additional Disclosures

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Generative artificial intelligence (AI) tools were used for drafting assessment question(s) and/or rationale(s). All AI-assisted content underwent human review, editing, and validation by qualified faculty and accredited education staff to ensure scientific accuracy, balance, and compliance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education.

Accreditation

Joint Accreditation Statement

In support of improving patient care, Clinical Care Options, LLC dba Decera Clinical Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Clinical Care Options, LLC dba Decera Clinical Education designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 0.5 contact hours.

Continuing Pharmacy Education

Clinical Care Options, LLC dba Decera Clinical Education designates this continuing education activity for 0.5 contact hours (0.05 CEUs) of the Accreditation Council for Pharmacy Education. Universal Activity Number: JA4008176-0000-26-566-H01-P

Type of Activity: Application

Upon successfully completing the post-test with a score of 65% or better and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 60 days.

Physician Associate Continuing Medical Education

Clinical Care Options, LLC dba Decera Clinical Education has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.5 AAPA Category 1 CME credits. Approval is valid until March 29, 2027. PAs should only claim credit commensurate with the extent of their participation.

IPCE Credit Designation

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This activity was planned by and for the healthcare team, and learners will receive 0.5 Interprofessional Continuing Education (IPCE) credits for learning and change.

CME Passport

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The CME credits that physicians earn from this activity will be submitted to ACCME's CME Passport, a free, centralized web application where you can create a personalized account to view, track, and generate transcripts of your reported CME credit. Visit www.cmepassport.org to create your account.