This segment reviews how clinicians evaluate CAR T-cell therapy suitability for an older patient with relapsed or refractory multiple myeloma who has cardiac disease, chronic kidney disease, fluctuating performance status, and rapidly progressive biochemical relapse. Dr. Kaur explains that well controlled comorbidities such as compensated heart failure and stage III chronic kidney disease are not exclusionary for CAR T; dose adjustments, coordinated cardio oncology and nephrology input, and careful monitoring can make these patients appropriate candidates. Dr. Raje emphasizes the need for immediate referral rather than delaying therapy, noting that early planning helps preserve eligibility and prevents disease related decline. Dr. Kaur also discusses the importance of aligning treatment choice with patient priorities, highlighting that CAR T provides a meaningful treatment free interval that can reduce hospital time compared with continuous therapies. Together, the discussion underscores how early evaluation, comorbidity optimization, and patient centered sequencing guide decision making for CAR T therapy.
