Chimeric Antigen Receptor T Cell (CAR-T) and Bi-specific Antibody (BsAb) therapies have shown unprecedented efficacy in heavily pretreated patients with Multiple Myeloma (MM). However, their use is associated with a significant risk of severe infections, which can be attributed to various factors such as Hypogammaglobulinemia, Neutropenia, Lymphopenia, T-Cell exhaustion, Cytokine-release Syndrome and Immune-effector, Cell-Associated Neurotoxicity Syndrome. Furthermore, Venous Thromboembolism (VTE) is a major complication in all Newly Diagnosed Multiple Myeloma (NDMM) patients.

Compared with the general population, patients with NDMM have a 9-fold increase in VTE risk, likely because of their malignancy, its treatments, and other additional patient-related factors. Importantly, NDMM patients who suffer VTE have shorter median overall survival (OS) compared to those who do not. Lastly, several metabolic risk factors such as obesity, diabetes mellitus, diet, exercise, and the human intestinal microbiome have been linked to the pathogenesis and outcomes in MM.

Full understanding and improved protection approach with CAR-T and BsAb therapies are essential. Adequate IVIG prophylaxis is set to lead to even greater utilization of replacement immune globulin for more adequate protection against infections. Considering that these modern therapies can often lead to lower CD4 counts, broad-spectrum antibiotics, prophylaxis for herpes simplex virus and/or varicella-zoster virus, prophylaxis against Pneumocystis Jirovecii and immune globulin replacement regardless of infection presence are just some of the new standards for patients on CAR-T and BsAb therapies. However, does the global community have the ability to meet these demands for all patients, on a continuous basis? How do we meet the challenge of easier access, and can CAR T and BsAb therapies achieve greater outpatient delivery?

Thromboembolic complications represent a preventable cause of morbidity and mortality in all NDMM patients, particularly in the era of novel therapies that have dramatically expanded the median OS in all patient groups. Are we aware of the true VTE risk with all modern induction regimens? Do dietary habits and the impact on gut microbiome represent an unexplored area to tackle in elevating long-term outcomes to even greater levels?

This Research Topic will focus on emerging areas of importance in the area of supportive care for Multiple Myeloma. These different themes will be the main focus of the contributing authors to address:

1. Evolving approaches in supportive care utilization and delivery for adequate infection prophylaxis with CAR-T and bi-specific antibody therapies in MM

2. Updated understanding of the ongoing and long-term VTE risks in NDMM patients treated with modern regimens

3. Feasibility and impact of outpatient delivery of CAR-T and BsAb therapy

4. Explore available evidence to date of the impact of dietary, exercise, and other lifestyle interventions on the gut microbiome, and on MM incidence, outcomes, and quality of life.

5. Other areas of cornerstone, comprehensive, multidisciplinary MM care including peripheral neuropathy and compression fracture management strategies

Are you interested in contributing a manuscript to this Research Topic?

Elevating Supportive Care Measures for Multiple Myeloma in the Modern Era