T-cell redirecting therapies in multiple myeloma: Barriers and knowledge gap among patients, community physicians, and caregivers

Abstract

Abstract Background: T-cell redirecting therapies (TCRT), including CAR T-cell and bispecific antibodies have emerged as a new pillar of treatment for relapsed or refractory multiple myeloma (MM). However, their adoption in real-world settings remains limited. Patients and caregivers often lack awareness of these therapies, while community physicians face barriers related to referral logistics, evolving treatment protocols, and limited access outside academic centers. Methods: This study assessed awareness, perceived barriers, and practical challenges surrounding TCRT among patients with MM, their caregivers, and community physicians. In June 2025, we distributed IRB-approved, anonymized, cross-sectional REDCap surveys at Atrium Health Wake Forest Comprehensive Cancer Center. The surveys were internally developed and reviewed for content validity. They were distributed to 3 stakeholder groups: patients with MM (25-item survey via MyChart), caregivers of patients receiving TCRT (22-item survey via email), and community-based physicians without direct access to TCRT (21-item survey via email). Surveys explored familiarity, perceived risks and benefits, access issues, referral practices, and informational needs. Descriptive statistics were used to analyze response trends. The primary objective was to assess TCRT utilization among previously treated patients with MM across racial groups, using prior MM treatment as a proxy for TCRT eligibility. Results: As of June 25, 2025, 390 respondents had initiated the surveys, including 313 patients, 47 caregivers, and 30 physicians. Among patient respondents, 17% were black, 80% white, 1% Asian and 2% other. Of those, 27% were unfamiliar with TCRT. Lack of awareness was higher among Black patients (35%) compared to non-Black (24%), and among those with high school education or less (44%) versus those with higher education (23%). Among patient-reported factors, only dichotomized education level was significant (p < 0.10), with higher education associated with twice the odds of TCRT utilization.About three-quarters of respondents noted no concern about participating in clinical trials, with similar rates between racial groups. TCRT utilization was 38% in Black patients and 39% among others. Among TCRT recipients, more Black respondents reported receiving TCRT as part of a clinical trial compared to non-Black respondents (47% vs. 35%). Most patients (90%) reported no challenges accessing TCRT, with similar rates across groups (Black: 87%, non-Black: 91%). Additionally, 86% would recommend TCRT without reservations (Black: 87%, non-Black: 85%). Among caregivers, 21% reported no prior knowledge of TCRT. Most (53%) experienced mental or emotional impacts from caregiving, and 62% reported moderate to high emotional stress during the patient's TCRT. Nearly one-third (32%) reported caregiving demands exceeding 40 hours per week. Emotional distress was the most cited challenge (55%), followed by isolation from family, friends and community (30%) and coordinating and attending appointments (28%). Most (89%) did not face challenges locating a TCRT treatment center. Physicians reported caring for diverse MM populations, with 17% treating fewer than 10% and 23% treating more than 50% patients from marginalized communities. While 70% had referred patients for TCRT, 48% reported that fewer than 25% of those referred received it. Ten percent were unfamiliar with TCRT, and although 63% had cared for patients post-TCRT, 30% felt not very or not at all comfortable doing so. A majority (73%) identified location as a moderate or major barrier to access, and 60% recommended improved transportation or logistical support for patients as the primary solution. Conclusion: Patients, caregivers, and community physicians face distinct yet overlapping barriers to TCRT access and understanding. Awareness gaps are more pronounced among Black patients and those with lower educational attainment. Despite comprising nearly 30% of our MM population, Black patients were underrepresented among survey respondents, highlighting potential participation bias. Caregivers report high stress due to emotional and logistical burdens. Physicians cite structural barriers, especially geography and transportation, as key obstacles. Targeted strategies are needed to enhance TCRT education, improve care coordination, and strengthen support systems across all stakeholders. Updated survey data will be provided at the time of presentation.