University of Chicago   

Most patients with PGNMID have no detectable disease in their marrow or blood and urine protein cannot adequately be monitored.

Let's assume they have cardiac involvement and transplant may not be feasible. 

Specifically, in the setting of patients that have had a PR or VGPR and are not actively progressing. 

Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion? 

i.e., 60+% bone marrow plasmacytosis, light chain ratio >100, and/or >1 MRI lesion

Ide-cel? Cilta-cel? Teclistamab?

Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?

What about multiple anaplastic plasmacytoma without bone marrow involvement?

Would you use MRD status to guide your decision making?