Access to T-Cell Redirecting Therapies in Multiple Myeloma: Patient, Caregiver, and Physician Perspectives on Awareness and Barriers

Background: T-cell redirecting therapies (TCRTs), including CAR T-cell therapies and bispecific antibodies, have transformed treatment for relapsed/refractory multiple myeloma (MM), yet real-world adoption remains limited by awareness and access barriers across patients, caregivers, and physicians. Methods: We conducted a cross-sectional study (June–September 2025) using IRB-approved REDCap surveys distributed to patients with MM (via MyChart), caregivers of TCRT recipients (via email), and community physicians (via email). Surveys assessed TCRT familiarity, perceived barriers, and access challenges. The primary objective was to compare TCRT utilization across racial groups among previously treated patients. Results: A total of 428 respondents participated (346 patients, 51 caregivers, 31 physicians). Among patients, 18% were Black. Overall, 26% were unfamiliar with TCRT, with higher unawareness among Black patients (32% vs. 25%) and those with ≤high school education (42% vs. 23%). Higher education was associated with twice the odds of TCRT utilization (p = 0.05). Among patients reporting prior MM treatment, TCRT utilization was similar across racial groups (39% Black vs. 38% non-Black). Among patients reporting TCRT receipt, Black patients more frequently reported receiving therapy through clinical trials compared with non-Black patients (44% vs. 34%). Among caregivers, 53% reported effects on mental/emotional wellness, 61% moderate-to-high stress during treatment, and 33% provided >40 h/week of care during month one. Among physicians, 71% referred patients for TCRT, but 48% reported <25% of referrals resulted in treatment. Patient hesitancy was the most cited referral barrier. Conclusions: Awareness gaps disproportionately affect Black patients and those with lower education. Caregivers experience substantial emotional and time burden. Patient hesitancy remains the primary barrier to TCRT referrals. Clinical trials may serve as an alternative access pathway for some patients. Multi-level interventions targeting education, caregiver support, and care coordination are needed to improve equitable TCRT access.