The biological rationale for this call is straightforward once the mechanics of CAR-T therapy are understood. Before engineered T-cells are infused, patients typically receive lymphodepleting chemotherapy, a regimen designed to suppress their existing immune system so that the infused cells can expand without being rejected. This creates a window of profound immunosuppression, often compounded by severe neutropenia, in which the body’s defenses against bacteria, fungi, and viruses are dramatically weakened. At the same time, many candidates for CAR-T have already been through multiple lines of chemotherapy, which damages the oral mucosa, alters saliva production, and disrupts the delicate microbial ecosystem of the mouth. The result is that even a routine dental infection or an untreated cavity can become a serious systemic threat precisely when the patient is most vulnerable.

The oral cavity is, in fact, one of the most microbiologically dense environments in the human body, harboring hundreds of bacterial species alongside fungi such as Candida albicans. When mucosal barriers break down, as they commonly do during intensive cancer therapy, these microorganisms can translocate into the bloodstream. Recent research on Candida has shown how fungal cells can cross the intestinal epithelial barrier, and the same principle applies to oral tissues. In a patient recovering from lymphodepletion and facing the inflammatory storm of cytokine release syndrome, a dental abscess or fungal overgrowth is not a minor inconvenience; it is a potential source of sepsis, treatment delay, or even failure of the CAR-T product itself. Niscola and Del Principe emphasize that oral infectious complications are among the avoidable hazards that a structured dental evaluation could help prevent.

Evidence supporting this concern is accumulating. A retrospective observational study published in the same journal examined oral manifestations and dental management in patients undergoing CAR-T cell therapy and documented a range of problems, including mucositis, infections, and xerostomia, the distressing dryness of the mouth that follows damage to salivary glands. Related work in patients who have undergone allogeneic hematopoietic stem cell transplantation, a closely related form of cellular therapy, has measured long-term changes in the immunological components of saliva, suggesting that glandular function and mucosal immunity may take months or years to recover, if they recover at all. These findings paint a picture of the mouth as a barometer of systemic vulnerability, one that changes measurably during and after aggressive immunotherapy.

The functional consequences extend beyond infection. New clinical data on swallowing outcomes after CAR-T treatment in patients with non-Hodgkin lymphoma have documented dysphagia, or difficulty swallowing, as a real and underappreciated complication of the therapy pathway. Taste disturbances, or dysgeusia, have also been reported in association with immunotherapy, and recent translational work has explored microbiome-aware nutritional strategies to address them. When eating becomes painful, difficult, or unappetizing, patients lose weight, malnutrition sets in, and recovery slows. Oral health, in other words, is not a cosmetic concern but a determinant of whether a patient can maintain the nutritional and physical resilience needed to weather the acute phase of CAR-T therapy and benefit from it in the long run.

Recognizing these risks, the international supportive care community has begun to respond. In 2025, the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology issued a joint clinical practice statement recommending dental evaluation and management before treatment for hematologic malignancies and before CAR-T cell therapy. The statement, authored by an expert panel including Zadik, Raber-Durlacher, Epstein, and colleagues, essentially formalizes what dental oncologists have long practiced: that patients scheduled for intensive immunotherapy should undergo a thorough oral examination, radiographic assessment, and stabilization of active disease before their immune system is deliberately dismantled. Niscola and Del Principe’s commentary can be read as both an endorsement of that guidance and a call to close the gap between recommendation and routine practice.

What would such integration look like in practice? The authors sketch a pathway that begins at patient selection, when a candidate for CAR-T is first identified. At that point, ideally weeks before lymphodepletion begins, a dentist or oral medicine specialist would assess caries risk, screen for periodontal disease and non-vital teeth, evaluate the condition of dentures and oral prostheses, and treat any source of potential infection. Preventive measures would include professional cleaning, fluoride application, and patient education on meticulous oral hygiene. During the hospital admission for infusion, the focus shifts to monitoring for mucositis, managing xerostomia with salivary substitutes or stimulants, and watching for early signs of oral candidiasis or herpes simplex reactivation. After discharge, follow-up dental visits would track healing, address persistent dry mouth or taste changes, and restore function as immune reconstitution proceeds.

The commentary also situates oral care within the broader architecture of CAR-T supportive management, which has grown increasingly sophisticated around toxicities such as cytokine release syndrome and immune effector cell-associated neurotoxicity. Guidelines for managing these systemic toxicities are now well established, and the authors suggest that oral supportive care deserves the same systematic attention. They point to their own prior work on mucosal toxicity in hematological malignancies, which reviewed prevention and management strategies across the spectrum of intensive therapies, as part of a growing literature arguing that the mucosal surfaces of the body are a frontline in cancer supportive care. The mouth, being simultaneously a sensory organ, a digestive gateway, and a microbial reservoir, sits at the intersection of several of these concerns.

There are practical challenges to implementing the vision. CAR-T therapy is delivered in a relatively small number of specialized centers, and patients often travel long distances for treatment, which complicates coordination with community dental providers. Many patients arrive with years of neglected dental care, particularly those whose cancer diagnosis interrupted routine checkups, and complete dental rehabilitation can take longer than the clinical window allows. Prioritization therefore becomes essential: treating active infection and removing unstable teeth take precedence over elective work, and the MASCC/ISOO statement offers a framework for triage. The authors argue that embedding a dental assessment checklist into the standard CAR-T workup, much as cardiac and infectious disease evaluations are already routine, would require modest resources but could prevent disproportionate harm.

Ultimately, the message of the commentary is one of integration rather than novelty. CAR-T cell therapy represents one of the most striking achievements of modern medicine, and its expanding applications across hematological malignancies continue to grow, as recent reviews of the field document. But the technology’s promise can only be realized if patients survive and thrive through the treatment window, and that depends on the unglamorous details of supportive care. Oral health, the authors contend, should no longer be an afterthought delegated to chance. By bringing dentists into the multidisciplinary team that plans and delivers CAR-T therapy, centers can reduce infectious complications, preserve nutrition and quality of life, and give patients the best possible chance of enjoying the remissions that this remarkable therapy can deliver.

Subject of Research: Integrating oral health and preventive dental care into CAR-T cell therapy supportive care

Article Title: Integrating oral health and preventive dental care into CAR-T cell therapy

Article References: Niscola, P., & Del Principe, M. I. (2026). Integrating oral health and preventive dental care into CAR-T cell therapy. Supportive Care in Cancer, 34(10), Article 1012. https://doi.org/10.1007/s00520-026-11268-8

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11268-8

Keywords: CAR-T cell therapy, oral health, preventive dental care, supportive care, hematologic malignancies, mucositis, immunosuppression, dysgeusia, dysphagia, oral infections, immunotherapy, MASCC/ISOO guidelines

Talquetamab belongs to an emerging class of T-cell-redirecting bispecific antibodies. It works by binding GPRC5D, a target abundantly expressed on malignant plasma cells, on one arm, and CD3 on T cells on the other, physically bridging the immune cell to the tumor and triggering a lethal synapse. The drug has shown impressive antimyeloma activity in patients whose disease had exhausted other options, and it was approved on the strength of those responses. But GPRC5D is also expressed in certain normal tissues, and the collateral consequences have become a defining feature of the treatment profile: dry mouth, nail changes, peeling skin, weight loss, and, most distinctively, dysgeusia, the distortion or loss of taste.

The Würzburg team, led by Anna Fleischer and colleagues, set out to move beyond the blunt binary of an adverse-event checklist. They combined objective taste-strip testing, in which filter-paper strips soaked with sweet, sour, salty, bitter, and umami solutions at four concentrations each are placed on the tongue, with a study-specific questionnaire, the EORTC QLQ-C30 quality-of-life instrument, and the PHQ-4 screening tool for anxiety and depression. Participants were asked to recall when their taste problems began, how their appetite and weight had changed, whether their food preferences had shifted, and whether they had ever considered abandoning the drug. The assessments took place during routine visits between 2024 and 2025, and patients were instructed to abstain from food, drink, smoking, and chewing gum for at least an hour beforehand.

The objective results were sobering. The median number of correctly identified taste stimuli was just 2.5 out of the administered panel, with an interquartile range of 0.75 to 7.25 and an observed range spanning zero to 14. Eight patients, 25 percent of the cohort, could not correctly identify a single taste. On the patient-reported side, the picture was equally stark: 15 of the 27 participants whose impairment could be graded described it as severe or very severe. Dry mouth, a frequent companion of taste loss, affected more than four in five patients. The symptom also arrived fast, with nearly 72 percent of participants recalling onset within 14 days of their first dose, a timing pattern that suggests the gustatory system is hit early in the course of treatment.

The most consequential finding, however, was the link between measured taste performance and appetite. Twenty patients, 62.5 percent of the cohort, reported currently reduced appetite, and their mean taste-identification count was 2.45, compared with 7.83 among those without current appetite reduction. That difference of 5.38 correct identifications, with a 95 percent confidence interval of minus 8.20 to minus 2.57 and a p-value of 0.0006, held up under rank-based sensitivity analysis and when a single participant with resolved appetite loss was excluded. In plain terms, patients whose tongues performed worse on the test were the same patients who had lost the desire to eat, a convergence of objective measurement and lived experience that strengthens the case that the sensory deficit carries real nutritional consequences.

The downstream effects on the body were visible in the numbers. Half of the participants reported directional weight loss since starting talquetamab, with a median loss of 4.5 kilograms and individual losses reaching 15 kilograms. Those reporting weight loss also scored substantially higher on the EORTC appetite-loss scale, 66.7 versus 33.3 points, although the binary appetite question and weight history did not align neatly, a discrepancy the authors attribute to the different time windows each measure captures. Food preferences had shifted in more than half of patients: savory and salty foods were favored by about 40 percent, while sweet foods and fruit appealed to a similar share, and a notable minority developed outright aversions to sweetness or alcohol. The heterogeneity, the authors note, argues against any one-size-fits-all dietary prescription.

Perhaps the most clinically alarming statistic concerns treatment persistence. Ten patients, nearly a third of the cohort, had seriously considered stopping talquetamab, and seven of them explicitly cited taste disturbance as a reason. That means roughly one in five patients in the study linked this sensory side effect to thoughts of abandoning an otherwise effective therapy. The authors are careful to distinguish these contemplations from actual nonadherence, since no missed doses or discontinuations were documented, but the signal is hard to ignore. In an era when bispecific antibodies are extending survival in myeloma, a side effect potent enough to make patients weigh quitting is a problem that supportive care can no longer treat as an afterthought.

Quality-of-life data reinforced the connection between taste and well-being. Mean global health status on the EORTC scale was 50.5 out of 100, and it correlated positively with taste-identification counts, with a Pearson correlation coefficient of 0.406 and a p-value of 0.021. Among patients whose current impairment could be graded, greater impairment tracked with both lower taste scores and lower global health. Role functioning and social functioning posted the lowest mean scores among the functional scales, while fatigue and appetite loss dominated the symptom scales. Psychological distress, measured by the PHQ-4, was heterogeneous rather than uniformly severe: just over half of participants showed minimal distress, about a third mild, and none severe, a reminder that taste loss can erode the pleasure of eating without necessarily registering as depression.

The authors are refreshingly candid about the limits of what a single-center, cross-sectional survey of 32 patients can establish. There was no pretreatment taste assessment, no contemporaneous comparator group, and no way to verify a norm-referenced hypogeusia classification from the aggregate counts retained in the records. Recalled onset dates and weight changes are vulnerable to memory distortions, the study-specific questionnaire was not a validated dysgeusia instrument, and the many exploratory associations were examined without correction for multiple comparisons. Crucially, a cross-sectional correlation cannot prove that talquetamab causes the taste loss, that taste loss causes the appetite reduction, or that the two share some third cause such as disease burden, oral infection, or other medications. The universal symptom reporting in this selected sample should also not be read as the true incidence of dysgeusia among all patients receiving the drug.

Even with those caveats, the study lands at a moment of genuine clinical need. Earlier work by the same group and others had described taste and oral symptoms under talquetamab, but this analysis is among the first to tie measured gustatory performance to appetite and quality of life within a single cohort, and to quantify how often the burden reaches the point of treatment doubt. The early onset narratives argue for proactive conversations about taste soon after the first dose, and the authors suggest that individualized exploration of tolerated flavors, textures, and hydration, alongside nutritional assessment when taste complaints, reduced intake, or weight change appear, is a reasonable supportive-care stance. What remains to be proven, they emphasize, is whether any of these strategies actually work: neither dietary adjustments nor dose modification has been tested prospectively. Future studies, they write, should track taste and patient-reported outcomes serially before, during, and after treatment, distinguish temporary improvement from sustained recovery, and preserve item-level taste responses so that the full sensory profile of this remarkable but demanding therapy can finally be mapped.

Subject of Research: Taste dysfunction, appetite loss, and quality of life in multiple myeloma patients treated with the bispecific antibody talquetamab

Article Title: Gustatory dysfunction under talquetamab therapy in multiple myeloma: a cross-sectional study of patient-reported course, nutritional changes, and quality of life

Article References: Fleischer, A., Burger, C., Roll, M., Panther, F., Strunz, P.-P., Peter, J., Kadel, S.-K., Gesierich, A., Mersi, J., Waldschmidt, J., Kortüm, M., Einsele, H., Maatouk, I., & Rasche, L. (2026). Gustatory dysfunction under talquetamab therapy in multiple myeloma: a cross-sectional study of patient-reported course, nutritional changes, and quality of life. Supportive Care in Cancer, 34(10), Article 1059. https://doi.org/10.1007/s00520-026-11288-4

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11288-4

Keywords: talquetamab, multiple myeloma, dysgeusia, bispecific antibody, GPRC5D, taste strips, appetite loss, weight loss, quality of life, supportive care, EORTC QLQ-C30, immunotherapy side effects

Meredith’s treatment history traces the modern arc of myeloma therapy. She began with the standard triplet of bortezomib, lenalidomide, and dexamethasone, gaining weight from the steroid but otherwise feeling relatively normal, before undergoing an autologous stem cell transplant in December 2019. That transplant proved grueling: a two-week hospitalization in Milwaukee, a three-hour drive from her hometown, and three to four weeks living within a 45-minute radius of the hospital afterward. She spent her birthday in a motel. Maintenance lenalidomide followed, but she relapsed roughly two years after diagnosis, moving on to daratumumab and carfilzomib, a combination that triggered fevers, facial swelling, emergency room visits, and repeated admissions for sepsis. A second relapse in March 2022 led to elotuzumab, pomalidomide, and dexamethasone, and her disease progressed again within months.

The commentary accompanying her account notes that Meredith’s disease moved faster than typical. In one analysis of United States electronic health records, the median time from first treatment to a second regimen was 46.7 months, and in a referral-center study the median time to a third treatment in relapsed patients was 16.6 months, both roughly twice the pace of Meredith’s progression. In a clinical study of daratumumab, carfilzomib, and dexamethasone, serious infections occurred in 19 percent of patients, but sepsis was not reported, underscoring how individual responses to the same regimens can diverge sharply from trial averages.

With few options remaining, Meredith enrolled in a clinical trial of chimeric antigen receptor T cell, or CAR-T, therapy in 2022. Bridged with daratumumab, bortezomib, and dexamethasone while increasingly ill, she received the engineered cells and spent four weeks hospitalized, developing severe cytokine release syndrome, a systemic inflammatory reaction in which immune cells flood the bloodstream with signaling proteins, that required several days in the intensive care unit. A later readmission for neutropenic fever followed. Recovery took months, but she emerged symptom- and treatment-free for 18 months, until May 2024, when a lesion on her sternum signaled yet another relapse. Her hematologist recommended talquetamab, a bispecific antibody she had never heard of, and with no clinical trials available to her, she agreed to try it.

Talquetamab works differently from CAR-T. It is a bispecific antibody that redirects T cells against GPRC5D, a protein abundant on myeloma cells, and it is approved for triple-class exposed relapsed/refractory multiple myeloma. Nurse practitioner Donna Catamero, who cares for myeloma patients at a large academic center and whose hospital enrolled the first patient on talquetamab monotherapy in the pivotal MonumenTAL-1 trial, describes two ideal candidates: patients needing a bridge to CAR-T therapy, and patients like Meredith who relapse while on a B cell maturation antigen, or BCMA, directed therapy such as a CAR-T product or a BCMA-targeting bispecific. In this heavily pre-treated population, she reports, complete remissions with durable responses have been observed, something rarely seen before in patients with so many prior therapies.

The drug’s side effect profile is distinctive because GPRC5D is also expressed in normal tissues. In MonumenTAL-1, cytokine release syndrome occurred in 75 to 79 percent of patients, but most events were low grade, occurred at or before the first full dose, and resolved, which is why step-up dosing and mandatory hospitalization during the initial doses are built into the treatment protocol. More than 70 percent of patients experience taste changes, and dry mouth, weight loss, rash, skin disorders, and nail changes are common. Skin and taste problems tend to appear within three to four weeks, while weight and nail changes develop more slowly. Rashes generally resolve within weeks, but taste, nail, and weight changes often persist, with modest improvement over time in most patients.

Meredith experienced this profile firsthand. She spent two weeks hospitalized at the start of treatment and had cytokine release syndrome, from which she recovered before discharge. Severe itching and red blotches on her face and body emerged first, managed with daily baths with bathing salts, allergy medications, and alcohol-free medical creams, resolving after five to six weeks. Nail discoloration and transient blurred vision followed. She lost 45 pounds during treatment, and the most burdensome effects were taste changes and dry mouth, which she managed by experimenting with cold liquids such as popsicles, ice cream, and smoothies, and soft foods including applesauce, mashed potatoes, pasta, and fish. After three to four months the side effects decreased substantially, and she is now in month 19 of treatment, feeling better emotionally and physically than she did after CAR-T.

The clinical machinery behind these outcomes is elaborate. Catamero’s team educates patients and care partners about cytokine release syndrome symptoms, including fever and hypotension, monitors vital signs every four to six hours during step-up dosing, and deploys intravenous fluids, oxygen, antipyretics, and, when needed, the interleukin-6 inhibitor tocilizumab or steroids. The US label advises that doses may be delayed to manage oral toxicity, and reducing dose frequency after a response is achieved has proven helpful and is supported by trial evidence. Dietitian Isabelle Wlodkowski provides mandatory nutrition consultations during the hospital stay, counseling patients on high-calorie, high-protein strategies, eight to ten cups of fluid daily for dry mouth, sugar-free gum, small frequent meals, and home weight tracking. A phase 2 study called TALISMAN is now using an objective instrument, the Waterless Empirical Taste Test, which preliminary results suggest can detect taste changes earlier than patient self-report and capture improvement as early as three months after treatment begins.

The transition from inpatient to outpatient care is where the multidisciplinary model earns its keep. Catamero emphasizes laboratory monitoring for infections and cytopenias, prophylaxis strategies, rapid pathways for evaluating fever, and proactive screening for skin and oral toxicities that patients often under-report until advanced. A safe handoff between a specialist center and a community oncologist depends on an explicit shared care plan covering dose schedules, prior cytokine release syndrome or neurotoxicity grades, 24/7 triage phone numbers, and shared toxicity algorithms. Patient advocate Becky Bosley of the International Myeloma Foundation stresses preparation for the hospitalization required during step-up doses, including delegating family and work responsibilities and planning financially for copays, and points to the foundation’s more than 150 myeloma-specific support groups and its AI-powered chatbot, Myelo, which answers questions using only information from myeloma.org.

Meredith’s care now spans a myeloma specialist, a local hematologist-oncologist, cancer nurses, a nutritionist, and an in-house patient advocate, with nursing staff having arranged treatment at a facility closer to home to ease the burden of traveling every other week. Her husband attends nearly every appointment, and she belongs to local and Mayo Clinic-affiliated support groups while following educational programming from the International Myeloma Foundation, the Multiple Myeloma Research Foundation, the Leukemia & Lymphoma Society, and the American Cancer Society. Her light chain lab values have been stable at every visit, her advice to new patients is to give the treatment six to eight weeks before judging it, and she teaches voice lessons, gardens, and exercises again. Her story illustrates a central message of the perspective: in relapsed myeloma, the drug is only half the treatment, and the coordinated team around it is what keeps patients on therapy and living well.

Subject of Research: Patient and clinician perspectives on living with relapsed/refractory multiple myeloma and multidisciplinary management of talquetamab therapy

Article Title: Perspectives on Living with Relapsed/Refractory Multiple Myeloma and Multidisciplinary Care from a Patient, Nurse Practitioner, Dietitian, and a Patient Advocate

Article References: Bosley, B., Wlodkowski, I., Catamero, D., & Meredith, S. (2026). Perspectives on Living with Relapsed/Refractory Multiple Myeloma and Multidisciplinary Care from a Patient, Nurse Practitioner, Dietitian, and a Patient Advocate. Advances in Therapy. https://doi.org/10.1007/s12325-026-03801-2

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03801-2

Keywords: multiple myeloma, relapsed/refractory myeloma, talquetamab, bispecific antibodies, CAR-T therapy, cytokine release syndrome, GPRC5D, dysgeusia, supportive care, oncology nutrition, patient advocacy, multidisciplinary care