Management of bone disease with concurrent chimeric antigen receptor T-cell therapy for multiple myeloma

• Published in: Critical reviews in oncology/hematology 2024-09, Vol.201, p.104429, Article 104429
• Main Authors: Kuruvilla, Davis, Huynh, Thien, Nester, Matthew, Chose, Chloe, Zervoudakis, Guston, Letson, G.Douglas, Joyce, David M., Binitie, Odion T., Figura, Nicholas B., Costello, James R., Freeman, Ciara L., Lazarides, Alexander L.
• Format: Article
• Language: English
• Subjects: Bone Diseases - diagnosis; Bone Diseases - etiology; Bone Diseases - immunology; Bone Diseases - therapy; Chimeric antigen receptor T-cell therapy (CAR-T); Humans; Immunotherapy, Adoptive - methods; Multiple myeloma; Multiple Myeloma - diagnosis; Multiple Myeloma - immunology; Multiple Myeloma - therapy; Orthopedics; Receptors, Chimeric Antigen - immunology; Surgery; Tumor Microenvironment - immunology
• ISSN: 1040-8428; 1879-0461; 1879-0461
• DOI: 10.1016/j.critrevonc.2024.104429

In the intricate landscape of multiple myeloma, a hematologic malignancy of plasma cells, bone disease presents a pivotal and often debilitating complication. The emergence of Chimeric Antigen Receptor T-cell (CAR-T) therapy has marked a pivotal shift in the therapeutic landscape, offering novel avenues for the management of MM, particularly for those with relapsed or refractory disease. This innovative treatment modality not only targets malignant cells with precision but also influences the bone microenvironment, presenting both challenges and opportunities in patient care. In this comprehensive review, we aim to examine the multifaceted aspects of bone disease in patients with multiple myeloma and concurrent CAR-T therapy, highlighting its clinical ramifications and the latest advancements in diagnostic modalities and therapeutic interventions. The article aims to synthesize current understanding of the interplay between myeloma cells, CAR-T cells, and the bone microenvironment in the context of current treatment strategies in this challenging and unique patient population. [Display omitted] •Radiation therapy use must be carefully timed and dosed to avoid compromising CAR-T.•Protective meds for myeloma bone disease in CAR-T therapy require special considerations.•Surgery for myeloma bone disease with CAR-T is only indicated if urgent or other treatments fail.•Patients should limit movement, rehab, and live with caregivers near center for 30 day post-CAR-T.