Bispecific Antibodies in Relapsed/Refractory Multiple Myeloma

In this segment, Dr. Peter Voorhees introduces the evolving role of bispecific antibodies in relapsed/refractory multiple myeloma, highlighting the movement of these therapies into earlier lines of treatment. Dr. Voorhees reviews the MajesTEC-3 study of teclistamab, a BCMA-directed bispecific antibody, in combination with daratumumab versus standard-of-care therapy in patients with relapsed/refractory multiple myeloma who had received 1 to 3 prior lines of therapy. Dr. Voorhees discusses the composition of the standard-of-care arm and notes that most patients received daratumumab, pomalidomide, and dexamethasone. He then highlights the substantial improvement in progression-free survival with the teclistamab-based regimen, along with higher overall response rates, complete response rates, and MRD negativity, as well as an overall survival benefit. The discussion also addresses the mechanism underlying infection risk with BCMA-directed therapy, including depletion of plasma cells and certain B-cell subsets and the resulting hypogammaglobulinemia. Dr. Voorhees emphasizes the importance of infection prophylaxis, including IVIG, antiviral prophylaxis, and PJP prophylaxis, during treatment.