(NSP-15) Supportive Clinical Care Pathways for Patients Receiving Bispecific Antibody and CAR T-cell Therapy for Multiple Myeloma

A clinical care pathway (CCP), also known as a care path, aims to incorporate best practices and guidelines into a standardized approach to care. Additionally, when integrated into the electronic medical record (EMR), pathways create institutional “best practices” for continuity of care and, when shared, promote these to referring centers. Patients (pts) with multiple myeloma (MM) represent an increasing population due to innovative therapies, including bispecific antibodies (BsAb) and chimeric antigen receptor T-cell (CART) therapies, which improve survival rates; yet, pts face unique care challenges such as infection complications, risk of relapse, and survivorship concerns. Thus, we aim to create and integrate a CCP into the EMR that incorporates international guidelines and best practices for the long-term management of pts on BsAb or after CART. 

Methods:

Our MM disease group identified the need for a standardized CCP for pts on BsAb or CART. To determine existing guidelines and practice patterns for a CCP, we conducted an extensive review of the literature, utilizing a search of electronic databases (CINAHL, Medline, Cochrane, and PubMed) that restricted publications to those in English between January 2020 and May 2025. We used the terms “clinical, care, path, pathway, myeloma.” Articles would be included if they proposed or reported the use of a supportive care model for MM pts receiving BsAb or after CART. Since the definition of pathway-directed therapy in MM examines genetic aberrations in tumor cells, these papers were excluded, and the search yielded no results. We then expanded the search to include a Google Scholar website search to find relevant papers.

Results:

The search identified 3 treatment pathways, including 2 in the US and 1 in Australia, but no supportive CCP in MM pts receiving BsAb or after CART. Three international guidelines published in the last 12 mos on immunotherapy and CART from the IMWG, NCCN, and TCT were reviewed. Best-practice recommendations from 1 collaborative pharmacy group and one international nurse leadership group were also considered. Consistent themes identified for pts receiving BsAb and after CART include the prevention and early detection of infection, monitoring for relapse, and the importance of survivorship strategies to support the physical, financial, and social aspects of immunotherapy delivery.

Conclusions:

International guidelines and best practices exist for the treatment of pts receiving BsAb or CART with MM. However, standardized guidelines and EMR integration is lacking. If CCPs exist, they are not widely disseminated. No published supportive CCPs for patients receiving BsAb and after CART were identified in this review. As effective care coordination is critical to ensure pts receive the correct infection prophylaxis, disease monitoring, and survivorship care, we aim to finalize a CCP and integrate it into the EMR  for consistent coordination of care in pts undergoing therapy with BsAB and after CART.