Multiple Myeloma Sequencing Evolves With CAR T, MRD Insights: Sylvester Homsy, MD

At the Institute for Value-Based Medicine® (IVBM) event held on March 31, 2026, in Charlotte, North Carolina, Sylvester Homsy, MD, of Atrium Health Wake Forest, contributed to the panel “Scaling Innovation: Delivering Targeted Therapies, CAR-T and Bispecifics in Multiple Myeloma.” His discussion centered on how rapidly advancing therapies—particularly chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies—are reshaping multiple myeloma treatment paradigms and challenging long-standing sequencing strategies.

Homsy reflected on how dramatically the field has evolved in just a few years.

“There was really no FDA-approved CAR T or even bispecific,” he said, describing earlier treatment approaches that relied heavily on combining and rotating existing regimens.

However, with the emergence of novel agents targeting the B-cell maturation antigen and other pathways, Homsy noted that everything changed, prompting a reevaluation of whether these therapies should be used earlier rather than reserved for later lines.

He emphasized that newer therapies are delivering unprecedented outcomes, as CAR T-cell therapies demonstrate response rates and progression-free survival unseen before, fundamentally altering clinical decision-making. This shift has introduced new complexity into sequencing, as clinicians must now weigh whether to exhaust traditional combinations or prioritize earlier intervention with highly effective novel treatments.

Homsy also highlighted the growing role of measurable residual disease (MRD) testing in guiding treatment. Once considered a secondary metric, MRD is now transforming how clinicians define response and tailor care.

“MRD testing has really changed how we perceive responses in myeloma,” he said, adding that it is increasingly being incorporated across all phases of treatment, from induction to maintenance.

Despite its promise, challenges remain. Homsy pointed to a lack of standardization across institutions and limited integration into formal guidelines. While MRD may soon become central to clinical pathways, he noted that its use is still largely confined to clinical trials and evolving practice patterns.

Aligned with broader IVBM discussions on access and equity, Homsy’s insights underscored a key tension in modern oncology: balancing rapid innovation with practical implementation. As novel therapies continue to move earlier in treatment, ensuring consistent access, infrastructure, and clinical clarity will be critical to translating these advances into improved patient outcomes.