BRIDGE-2M: Optimizing Bridging Therapy Prior to CAR-T Therapy in Multiple Myeloma: A Modified Double-Blind Delphi Panel of US Physicians

INTRODUCTION: We aimed to achieve consensus on optimal bridging therapy (BT) selection for patients with relapsed/refractory multiple myeloma (RRMM) undergoing chimeric antigen receptor T-cell (CAR-T) therapy. METHODS: We conducted a double-blind, three-round modified Delphi panel among U.S.-based hematologist-oncologists/hematologists using CAR-T therapy for RRMM. RESULTS: Panelists (N = 15; all managing -60-100 patients with RRMM within the past year; > 5 years of practice: 86.7%) reached consensus on key attributes influencing BT selection (disease burden, aggressive disease, performance status, comorbidities, line of therapy, age, frailty). Unique patient attributes were linked to clinical objectives (≥ 65 years or frailty: disease stabilization [71% consensus]; poor performance status: end-organ function preservation; comorbidities: functional preservation; high disease burden: preventing clinical decline; aggressive disease: cytoreduction [all 100% consensus]). Goals of BT were to decrease disease burden and promote CAR-T efficacy and safety (100% consensus). While talquetamab was preferred for bridging in later lines (66.7%), 73.3% would consider earlier-line use if approved. CONCLUSION: This study synthesized expert physician perspectives to develop a consensus-based framework to optimize BT selection, linking five key patient attributes to clinical objectives, with goals extending beyond disease stabilization to enhancing CAR-T efficacy and safety. Graphical abstract available for this article 10.6084/m9.figshare.33016328.