Al-Ola A Abdallah, Associate Professor at the University of Kansas Medical Center, shared on X:
“Just published in Cancers from the USMIRC: CAR-T vs BiTE
One of the largest multicenter real-world studies comparing BCMA-directed CAR-T therapy with bispecific antibodies in relapsed/refractory multiple myeloma.
We analyzed 356 patients across 7 US academic centers.
In patients receiving their first BCMA-directed therapy (n=276):
- CAR-T: 169 patients
- Teclistamab: 107 patients
Overall response rate was 87% with CAR-T versus 68% with teclistamab.
CAR-T also produced deeper responses:
- Stringent complete response: 24% vs 3.9%
- Median PFS: 16.1 vs 13.5 months
- p=0.007
The PFS benefit remained significant after statistical adjustment.
Overall survival was not significantly different in the initial unadjusted analysis, although adjusted models showed a signal favoring CAR-T.
Longer follow-up is needed to clarify the survival impact.
Outcomes were less favorable after prior BCMA-directed therapy:
- CAR-T: ORR 64%; median PFS 6.3 months
- Bispecific antibody: ORR 53%; median PFS 4.4 months
Prior BCMA exposure appears to reduce the durability of both approaches.
Sequencing may matter.
The best responses after prior BCMA therapy were observed when patients received a different BCMA modality after a washout period longer than 6 months.
These exploratory findings require prospective validation.
Safety profiles were different:
- CAR-T caused more cytopenias
- Teclistamab was associated with more acute infections
- Severe ICANS rates were similar
Treatment selection should consider efficacy, urgency, access, comorbidities, and supportive-care needs.
Important limitations include the retrospective, nonrandomized design, baseline differences between groups, shorter follow-up, and the inclusion of teclistamab as the only bispecific antibody.
These findings should guide-not replace-prospective trials.
Key message
CAR-T was associated with deeper and more durable responses when used before prior BCMA exposure.
After BCMA therapy, outcomes with either approach were less durable, highlighting the importance of thoughtful sequencing and alternative targets.”
Title: Sequencing BCMA-Directed Therapies in Relapsed/Refractory Multiple Myeloma: A Real-World Comparison of CAR T-Cell Therapy and Bispecific Antibodies
Authors: Osama M. Younis, Sencer Goklemez, Carmel Awadallah, Shebli Atrash, Barry Paul, Hira Shaikh, Christopher Strouse, Andrew Vegel, Emily Struble, Anita Mazloom, Omar Alkharabsheh, Prerna Mewawalla, Mansi R. Shah, Abhiraj Saxena, Zahra Mahmoudjafari, Jordan Snyder, Muhammad Umair Mushtaq, Jeries Kort, Alma Habib, Joseph McGuirk
