Who Is Eligible for CAR-T Therapy for Multiple Myeloma? 2026 Patient Guide

Updated: September 2026

CAR-T cell therapy may be an option for adults with multiple myeloma that has returned after treatment or stopped responding to treatment.

Eligibility is not determined by the diagnosis alone. The reviewing team considers the treatments the patient has already received, the current behavior of the disease, general health, organ function, infection status and whether the patient can safely complete the CAR-T process.

For international patients, it can be useful to request an eligibility review before all remaining treatments have been exhausted. An early review allows the CAR-T team to consider the treatment sequence, determine whether additional tests are required and plan how the disease could be controlled while the CAR-T cells are being prepared.

Read patient testimonials >>

Who may qualify for CAR-T therapy for multiple myeloma?

A patient may be considered for CAR-T when:

• The diagnosis of multiple myeloma has been confirmed.
• The disease has relapsed or is refractory to treatment.
• The patient has received the required previous treatment lines.
• The disease is currently measurable or otherwise assessable.
• The patient has adequate heart, lung, liver and kidney function.
• Blood counts are sufficient for treatment or can be medically managed.
• There is no uncontrolled active infection.
• The patient is physically stable enough to undergo cell collection, preparatory chemotherapy and hospitalization.
• The disease can be controlled until the CAR-T infusion.
• The patient and caregiver can remain near the treatment center for the required monitoring period.

These are general considerations. The final decision is made by the treating CAR-T program after reviewing the complete medical record.

How many previous treatment lines are required?

The number of required previous treatments depends on the CAR-T product, the country, the treatment program and the patient’s individual situation.

In the United States, the FDA indication for Carvykti includes selected adults with relapsed or refractory multiple myeloma after at least one previous treatment line. The previous treatment must have included a proteasome inhibitor and an immunomodulatory agent, and the disease must be refractory to lenalidomide.

The FDA indication for Abecma includes adults with relapsed or refractory multiple myeloma after at least two previous treatment lines, including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 antibody.

These FDA indications apply to the use of these commercial products in the United States. They do not automatically determine eligibility for treatment in Israel or another country.

International patients applying to Israeli CAR-T programs are commonly reviewed after failure of two or three treatment lines, depending on the treatment protocol, previous drugs, current response and availability. Some patients may be reviewed earlier when the disease is considered high risk or when future treatment planning is particularly important.

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Which previous drugs are important?

The reviewing team needs to know whether the patient has already received treatments from the main drug classes used for multiple myeloma.

These may include:

• Proteasome inhibitors such as bortezomib, carfilzomib or ixazomib
• Immunomodulatory drugs such as lenalidomide, pomalidomide or thalidomide
• Anti-CD38 antibodies such as daratumumab or isatuximab
• Chemotherapy
• Corticosteroids
• Autologous stem cell transplantation
• Bispecific antibodies such as teclistamab, elranatamab or talquetamab
• A previous CAR-T treatment
• Other clinical-trial or targeted treatments

A list of drug names alone is not enough. The medical summary should state when each treatment was given, the number of cycles, the best response, how long the response lasted and why the treatment was stopped.

What does relapsed or refractory multiple myeloma mean?

Relapsed multiple myeloma means that the disease initially responded to treatment but later returned or began progressing again.

Refractory multiple myeloma means that the disease did not respond adequately or progressed during treatment or shortly after it ended.

Both situations may lead to consideration of CAR-T. However, the timing and pattern of progression matter.

A patient whose disease returned after a long remission may have different treatment options from a patient whose myeloma progressed during several consecutive therapies.

Does the patient need to be in remission before CAR-T?

No. CAR-T is generally considered for active relapsed or refractory multiple myeloma, so the patient does not need to be in complete remission.

However, the disease must be sufficiently controlled for the patient to reach the CAR-T infusion safely. Patients with very rapidly progressing disease, severe organ damage or a very high disease burden may need additional treatment before CAR-T.

This temporary treatment is known as bridging therapy. It may be given after T-cell collection while the CAR-T cells are being manufactured.

The choice of bridging therapy is important because some treatments can affect T-cell function or target the same protein as the planned CAR-T. Bridging treatment should therefore be coordinated with the CAR-T team whenever possible.

What health factors affect CAR-T eligibility?

CAR-T treatment places significant stress on the immune system and can cause complications that require hospitalization and close monitoring.

The team will normally review:

• General physical condition and ability to manage daily activities
• Heart function
• Lung function
• Kidney function
• Liver function
• Blood counts
• Neurological history
• Current or recent infections
• Previous treatment complications
• Other cancers or serious medical conditions
• Current medications
• Ability to tolerate lymphodepleting chemotherapy

A medical condition does not always lead to automatic exclusion. The team considers its severity, whether it is controlled and how it may affect treatment safety.

Read patient testimonials >>

Is there an age limit for CAR-T therapy?

There is no single universal upper age limit for CAR-T therapy.

Age is considered together with physical function, frailty, organ function, cognitive status and other medical conditions. A medically fit patient in their seventies may be a better candidate than a younger patient with an uncontrolled infection or severe organ dysfunction.

Studies increasingly suggest that carefully selected older patients can receive CAR-T with meaningful results. However, older patients may require a more detailed assessment of frailty, mobility, caregiver support and ability to recover from complications.

Chronological age alone should not be used to decide that a patient is ineligible.

Can a patient with kidney problems receive CAR-T?

Kidney function is an important part of the eligibility review, particularly because patients must receive preparatory chemotherapy before the CAR-T infusion.

Mild or moderate kidney impairment does not always exclude treatment. The team will consider:

• The cause and severity of the kidney impairment
• Whether kidney function is stable
• Whether the myeloma is contributing to the problem
• Electrolyte levels
• The need for dialysis
• Whether chemotherapy doses can be adjusted safely

Severe or unstable kidney failure may complicate treatment, but the decision must be made individually.

Can a patient with heart or lung disease receive CAR-T?

Patients with controlled heart or lung conditions may still be considered.

The concern is that cytokine release syndrome can cause fever, low blood pressure, rapid heart rate and breathing difficulties. Patients must have enough cardiovascular and respiratory reserve to tolerate these possible complications.

The assessment may include an electrocardiogram, echocardiogram, oxygen evaluation, lung-function testing or specialist clearance, depending on the medical history.

Unstable heart disease or severe respiratory impairment may delay or prevent treatment.

Can a patient receive CAR-T with an active infection?

An uncontrolled active infection will usually delay CAR-T therapy.

CAR-T and the preparatory chemotherapy weaken the immune system. Proceeding with an active bacterial, viral or fungal infection could create a serious safety risk.

The team may request testing for:

• Hepatitis B and C
• HIV
• CMV and other viruses
• Tuberculosis in selected cases
• Respiratory infections
• Blood or urine infections
• Other infections based on the patient’s history and country of residence

A previous infection does not necessarily make the patient ineligible. The team needs to determine whether it has resolved or can be safely controlled.

Is previous stem cell transplantation a problem?

A previous autologous stem cell transplant does not normally exclude CAR-T treatment.

Many patients considered for CAR-T have already undergone an autologous transplant. The reviewing team will examine:

• The date of the transplant
• The response achieved
• How long the response lasted
• Any serious transplant-related complications
• Current bone marrow function
• Treatments received since the transplant

CAR-T may also be considered for some patients who were not suitable for a stem cell transplant, depending on their current medical condition.

Can a patient receive CAR-T after teclistamab or another bispecific antibody?

Previous treatment with a bispecific antibody does not automatically rule out CAR-T.

However, the treatment target and sequence may affect the decision. Teclistamab and elranatamab target BCMA, which is also the target of the established CAR-T therapies for multiple myeloma. Talquetamab targets GPRC5D.

The CAR-T team will consider:

• Which bispecific antibody was used
• How long it was given
• Whether the patient responded
• Why it was stopped
• The time since the last dose
• Current blood counts and infection status
• Whether the disease still expresses the intended CAR-T target
• Whether sufficient T cells can be collected

Patients considering a bispecific antibody should ideally request a CAR-T review before beginning treatment when this is medically practical. This can help preserve future options and allow the sequence to be planned.

Read more about choosing between CAR-T and a bispecific antibody for multiple myeloma.

Can a patient receive CAR-T after a previous CAR-T treatment?

A previous CAR-T treatment does not always eliminate the possibility of another cellular therapy.

The reviewing team will need to understand:

• Whether the first CAR-T produced a response
• How long the response lasted
• Why the disease returned
• Whether the original target remains present
• Which CAR-T product or protocol was used
• Whether a treatment targeting a different protein is available
• Whether the patient remains medically fit

Options after CAR-T failure differ substantially between patients and may include bispecific antibodies, another CAR-T approach, targeted therapy, chemotherapy, transplantation or a clinical trial.

Read more about treatment options when CAR-T does not work or the cancer returns.

Why might CAR-T not be recommended?

CAR-T may not be recommended when the expected risks are considered greater than the possible benefit.

Possible reasons include:

• The diagnosis or disease subtype is not suitable for the available protocol.
• The patient has not received the required previous treatments.
• The disease is progressing too quickly to complete the CAR-T process.
• Severe organ dysfunction makes treatment unsafe.
• An infection cannot be controlled.
• The patient cannot receive lymphodepleting chemotherapy.
• Adequate T cells cannot be collected or manufactured.
• The myeloma no longer expresses the intended target.
• The patient’s general condition is too poor for safe treatment.
• Another available treatment is considered more appropriate.

A rejection by one treatment center or under one protocol does not necessarily answer whether every CAR-T pathway is unsuitable. However, medical records must be reviewed before another opinion can be meaningful.

When should a patient request a review?

A review may be appropriate when:

• Multiple myeloma has returned or stopped responding.
• The patient has completed two or more treatment lines.
• A stem cell transplant has failed or is not suitable.
• The treating doctor is considering teclistamab, elranatamab or talquetamab.
• CAR-T is unavailable or substantially delayed in the patient’s country.
• The patient has been placed on a long waiting list.
• The patient needs an additional opinion about CAR-T eligibility.
• The disease is currently stable enough to allow treatment planning.

Patients should not stop or delay medically necessary treatment while waiting for an international review.

Request a CAR-T eligibility review

Israeli Hospitals coordinates medical-record reviews for international patients with relapsed or refractory multiple myeloma.

The records are reviewed to determine whether CAR-T may be medically relevant, whether additional documents or tests are required and which next steps can be considered.

Every application is assessed individually. A diagnosis of multiple myeloma, a specific number of previous treatments or submission of medical records does not guarantee eligibility, acceptance, treatment availability or a particular outcome.

Contact us to submit the patient’s medical records for an individual CAR-T eligibility review.

Sources

1. U.S. Food and Drug Administration. CARVYKTI: indications and product information .
2. U.S. Food and Drug Administration. ABECMA: indications and product information .
3. Pophali P, Rosenblatt J, Avigan D. CAR-T cell therapy for multiple myeloma: An update on the current state and future potential . Best Practice & Research Clinical Haematology. 2025.