Optimizing ciltacabtagene autoleucel outcomes: real-world experience and best practices from a single academic center

Ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR-T) therapy, has transformed the management of relapsed or refractory multiple myeloma and demonstrated long-term, treatment-free remissions in patients (CARTITUDE-1: median overall survival, 60.7 months and 33% of patients with progression-free survival ≥5 years). While pivotal clinical trials have demonstrated unprecedented depth and durability of response, the real-world populations can sometimes diverge from trial-eligible cohorts, with greater age variability, comorbidity burden, functional limitations, and logistic challenges that may impact outcomes. As cilta-cel adoption expands across treatment centers into the community and outpatient settings, generating real-world evidence and best practices is critical to ensuring that the transformative potential of this therapy is realized safely and effectively. This is a single-center report on our experience implementing cilta-cel. We share practical strategies that have supported favorable safety and clinical outcomes across the treatment continuum-beginning with patient selection, baseline risk assessment and pre-infusion optimization, through acute monitoring and management of adverse events, to longer-term follow-up. We highlight the importance of structured workflows, multidisciplinary coordination, early referral pathways, anticipatory guidance, and collaborative care models in achieving safe and effective outcomes. As centers continue to refine cilta-cel implementation, these institutional insights will play a key role in shaping best practices for patients receiving CAR-T therapy.