Managing Novel CAR T-Cell Toxicities in Multiple Myeloma

B-cell maturation antigen (BCMA) targeted chimeric antigen receptor T-cell (CAR-T) cell therapy has proven highly efficacious for relapsed multiple myeloma, inducing deep and durable remissions. Recent reporting has bolstered significant enthusiasm, describing upwards of one-third of patients in continued remission, 5 years following BCMA CAR-T without receiving any subsequent therapy, suggesting the possibility that this treatment may offer the hope of a cure. There are many well-characterized side effects from CAR-T, and mitigation strategies have been established to make this therapy safe. However, as the use of CAR-T cells has become more widespread, several novel and unanticipated side effects have emerged. These novel toxicities of CAR-T can be delayed, occurring within the first 3 to 6 months, and can be life-threatening or life-altering. Thus, early detection and timely management are essential. This comprehensive review will cover the diagnosis and management of common and emerging toxicities associated with CAR T-cell therapy for multiple myeloma.