Outcomes of CAR T-cell Therapy and Bispecific Antibodies as Single-Modality and Sequential Strategies in Relapsed/Refractory Multiple Myeloma
In the largest real‑world comparison of patient outcomes following CAR‑T and bispecific antibodies in relapsed myeloma, CAR T‑cell therapy is associated with higher and more durable responses over bispecifics, while sequencing CAR‑T then BsAb offers maximal benefit overall.
We explored single or consecutive chimeric antigen receptor (CAR) T and bispecific antibody (BsAb) treatment modalities as correlates of clinical outcomes, by complementary bias‑correction analysis of a retrospective multicenter study of 640 patients with relapsed/refractory multiple myeloma. The sequential use of both modalities seemed to yield the most favorable survival trajectories. Initiating treatment with CAR T [idecabtagene vicleucel (ide‑cel), ciltacabtagene autoleucel (cilta‑cel), cesnicabtagene autoleucel (cesni‑cel)] was associated with longer remission. However, mortality from early progression was similar regardless of initial modality, suggesting that resistance may negate initial efficacy difference. On the product level, the benefit of CAR T seemed to be driven by cilta‑cel and cesni‑cel, whereas BsAbs showed at least comparable outcomes with ide‑cel. These exploratory findings highlight the critical importance of treatment sequencing in optimizing long-term outcomes and underscore the need for equitable and timely access to both modalities across healthcare systems.
Chief findings from a large real‑world European study highlight that CAR‑T therapies are associated with longer remission compared with bispecific antibodies, and that sequencing both modalities (CAR‑T followed by BsAb) yields the most favorable outcomes. These results underscore the importance of treatment sequencing and the need for equitable access to both modalities in routine clinical practice.
Evidence level: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.
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