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Multiple myeloma (MM) is a plasma cell neoplasm that accounts for approximately 1–2% of all cancers and remains predominantly incurable despite significant improvements in patient survival over the past 20 years.1,2 Many patients eventually develop relapsed or refractory MM (RRMM), with progression-free survival (PFS) often less than 6 months.1-3 Chimeric Antigen Receptor (CAR) T cell therapy has revolutionised cancer treatment by using the patient’s own genetically modified T cells to specifically recognise and bind to patient-specific tumour antigens.2 Current treatment guidelines recommend prioritising B-cell maturation antigen (BCMA) directed CAR-T cell therapies as first-line immunotherapy for eligible patients with RRMM, while reserving BCMA-targeting bispecific antibodies for subsequent lines or for patients who are not eligible for CAR-T cell therapy, and reserving antibody-drug conjugates for early relapse settings.1, 4-7
There are currently two BCMA-directed CAR-T cell therapies approved for RRMM: ciltacabtagene autoleucel and idecabtagene vicleucel,8,9 both of which have demonstrated high response rates with durable remission, suggesting the potential to achieve long-term disease control in patients with RRMM.7,10,11 Ciltacabtagene autoleucel is the first and only approved second line or later CAR-T cell therapy for adult patients with lenalidomide-refractory MM who have received at ≥1 prior therapy, including a proteasome inhibitor (PI) and an immunomodulatory agent, and demonstrated disease progression on prior therapy.8,10 Idecabtagene vicleucel is approved in adult patients with triple-class exposed MM after ≥2 prior treatments including an immunomodulatory agent, a PI, and an anti-CD38 monoclonal antibody.9,11 The mechanism of action of CAR-T cell therapies may help to address unmet medical needs by harnessing the power of the immune system and ciltacabtagene autoleucel may provide physicians with an earlier treatment option at first relapse.2
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Dimopoulos MA, Moreau P, Terposet E, et al. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32:309-322.
Sheykhhasan M, Ahmadieh-Yazdi A, Vicidomini R, et al. CAR T therapies in multiple myeloma: unleashing the future. Cancer Gene Ther. 2024;31:667-686.
Jagannath S, Martin TG, Lin Y, et al. Long-Term (≥5-Year) Remission and Survival After Treatment With Ciltacabtagene Autoleucel in CARTITUDE-1 Patients With Relapsed/Refractory Multiple Myeloma. J Clin Oncol. 2025;43:2766-2771.
NCCN Guidelines. Multiple Myeloma, Version 5.2026. Available at: www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf (accessed 5 May 2026).
Lin Y, Qui L, Usmani S, et al. Consensus guidelines and recommendations for the management and response assessment of chimeric antigen receptor T-cell therapy in clinical practice for relapsed and refractory multiple myeloma: a report from the International Myeloma Working Group Immunotherapy Committee. Lancet Oncol. 2024;25(8)e374-e387.
Han L, Wang K, Jiang Z, et al. Recent development in bispecific antibody immunotherapy for hematological malignancies. Crit Rev Oncol Hematol. 2025;212:104752.
Puppi M, Sacchetti I, Mancuso K, et al. Bispecific Antibodies and CAR T in Multiple Myeloma: Appropriate Selection of Patients and Sequencing. Mediterr J Hematol Infect Dis. 2025;17:e2025045.
CARVYKTI® (ciltacabtagene autoleucel) Highlights of prescribing information. Available at: www.janssenlabels.com/package-insert/product-monograph/prescribing-information/CARVYKTI-pi.pdf (accessed 5 May 2026).
Idecabtagene vicleucel. Prescribing information. Celgene Corporation 2021. Available at: www.fda.gov/media/147055/download (accessed 5 May 2026).
van de Donk NWCJ, Moreau P, San-Miguel JF, et al. Sequencing BCMA- and GPRC5D-targeting immunotherapies in multiple myeloma: Practical guidance from the European Myeloma Network. Hemasphere. 2025;9:e70260.
Munshi NC, Anderson LD Jr, Shah N, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2021;384:705-716.
Beatrice Razzo, MD, is an Assistant Professor of Medicine at Thomas Jefferson University in Philadelphia, Pennsylvania. Her clinical expertise centres on multiple myeloma and related plasma cell disorders. Her research focuses on clinical and translational strategies to better inform the selection, sequencing and optimal duration of T-cell–redirecting therapies in multiple myeloma. Prof. Razzo has led and contributed to pragmatic clinical trials and real-world studies evaluating teclistamab in relapsed/refractory multiple myeloma, with an emphasis on treatment effectiveness, toxicity and the role of immune fitness.
Advisory board honoraria from Johnson & Johnson. Honoraria from touchMEDICAL.
Shaji K. Kumar, MD, is a Consultant in the Division of Hematology and the Mark and Judy Mullins Professor of Hematological Malignancies at the Mayo Clinic in Rochester, Minnesota. He serves as Chair of the Myeloma, Amyloidosis and Dysproteinemia Disease Group at the Mayo Clinic, as well as Research Chair for the Division of Hematology. Prof. Kumar’s research centres on developing new drugs and drug combinations for treating myeloma; he is the Principal Investigator of multiple Phase 1, 2 and 3 clinical trials. Additionally, he studies the mechanisms behind disease progression from precursor conditions and risk stratification of plasma cell disorders. His laboratory aims to understand the role of the bone marrow microenvironment in the development and progression of myeloma. Prof. Kumar serves as Chair of the NCCN Multiple Myeloma Guidelines Panel, and he is the President of the International Society of Amyloidosis and the Vice President of the International Myeloma Society.
Research support for clinical trials from AbbVie, Adaptive, Celgene, Janssen, Kite, MedImmune/AstraZeneca and Takeda. Advisory Board honoraria from AbbVie, Adaptive, Celgene, Janssen, Kite, MedImmune/AstraZeneca, Merck, Novartis, Roche, Sanofi and Takeda. Independent Review Committee participation for Oncopeptides. Honoraria from touchMEDICAL.
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This activity is supported with funding from Legend Biotech. This activity is provided by touchMEDICAL for touchONCOLOGY.
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Date of preparation: May 2026
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