Outcomes of CAR-T cell therapy and bispecific antibodies as single-modality and sequential strategies in relapsed/refractory multiple myeloma

We explored single or consecutive CAR-T and 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. Sequential use of both modalities appeared to yield the most favorable survival trajectories. Initiating treatment with CAR-T (ide-cel, cilta-cel, 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 product level, the benefit of CAR-T appeared to be driven by cilta-cel and cesni-cel, whereas BsAb showed at least comparable outcomes to 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.