Significant strides have been made in the management of patients living with myeloma. However, patients with multiply relapsed or refractory multiple myeloma (MM) have a shorter overall survival; therefore, new treatments with novel mechanisms of action are needed in this patient population. Patients with relapsing disease require a full restaging work-up, including whole body imaging to evaluate for extramedullary disease and lytic bone lesions, as well as bone marrow biopsy with fluorescence in situ hybridization to determine if the patient has any new chromosomal changes that are present. Therapies utilizing the patient's immune cells, in particular T cells, provide a new option in relapsed/refractory myeloma. Treatment utilizing chimeric antigen receptor (CAR) T cells and/or bispecific antibody therapy provide excellent response rates. As such, advanced practitioners need to be aware of the potential toxicities associated with these newer treatments and how to manage them. This article will focus on the management of patients with relapsed and/or refractory disease who are undergoing treatment with either CAR T-cell therapy or bispecific T cell engager therapy.
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