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Integrating Palliative Care into Relapsed/Refractory Multiple Myeloma in the Immunotherapy Era: A Narrative Review

Muhanad Alzahrani1, Zaid Musaad Alsharif1, Ziyad Alzahrani2

  • 1Ministry of Health, Jeddah, Saudi Arabia.

Journal of Pain & Palliative Care Pharmacotherapy
|September 4, 2026
PubMed

Relapsed/refractory multiple myeloma (RRMM) has been transformed by T-cell-redirecting immunotherapies, including chimeric antigen receptor T-cell therapy and bispecific antibodies. Despite unprecedented response rates in heavily pretreated patients, these treatments impose complex and sustained toxicities, substantial logistical demands, and existential distress. Palliative care integration in this setting remains underexplored. We conducted a narrative synthesis using a systematic-style search of PubMed/MEDLINE and Web of Science, identifying 315 records. After deduplication and title and abstract screening, 51 reports underwent full-text review. Eighteen primary studies were included, and 12 supplementary references were added for contextual support, yielding 30 citations overall. Six thematic domains emerged: the relevance of palliative care in RRMM; quality of life and patient-reported outcomes; supportive and palliative care challenges during immunotherapy; communication and shared decision-making; caregiver burden; and practical models for integration. Early, concurrent palliative care integration in RRMM immunotherapy is warranted and feasible and should be evaluated prospectively.

Keywords:
CAR-tMultiple myelomabispecific antibodycaregiver burdenpalliative carequality of liferelapsed/refractorysupportive care

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