Understanding the Role and Clinical Management of Bridging Therapy During CAR T-Cell Therapy for Relapsed or Refractory Multiple Myeloma.

Background: Chimeric antigen receptor (CAR) T-cell therapy has emerged as a highly effective treatment for relapsed or refractory multiple myeloma (MM). However, manufacturing CAR T cells can take 3 to 4 weeks, leaving patients vulnerable to disease progression during this waiting period. Bridging therapy aims to address this gap by controlling disease and improving CAR T-cell efficacy. Objectives: This review summarizes the role of bridging therapy in CAR T-cell therapy for MM, focusing on the rationale and goals of bridging therapy, timing of initiation, infection risk management, selection of bridging regimens, and clinical implications, including patient education and communication. Methods: Relevant literature on CAR T-cell therapy and bridging therapy in MM was reviewed, including clinical trials and real-world data. Findings: Bridging therapy may be crucial for some patients, particularly for those with rapidly progressive disease. The optimal timing for initiating bridging therapy remains under investigation, but it can begin as soon as leukapheresis is completed. Prophylactic antibiotics or antivirals and close monitoring are essential for preventing infections during this period. The choice of bridging regimen depends on individual patient characteristics and prior therapies. Effective patient education and communication between local oncology teams and CAR T-cell centers are critical. Implications: Bridging therapy plays a vital role in optimizing CAR T-cell therapy outcomes for MM patients. Further research is needed to define the optimal use of bridging therapy in this evolving treatment landscape.