How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?  

For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cytopenias (in areas with lots of bone marrow like the hip) causing problems with IMiDs, cyclophosphamide, or other therapies that can cause cytopenias, including CAR-T therapy. Is this something that should be avoided?