Rinsho Ketsueki. 2026;67(9):1257-1270. doi: 10.11406/rinketsu.67.1257.
ABSTRACT
T-cell redirecting therapies, particularly BCMA-directed CAR-T-cell therapy and bispecific antibodies, have substantially advanced the treatment of multiple myeloma. These therapies induce deep responses in patients with relapsed or refractory disease after exposure to proteasome inhibitors, immunomodulatory drugs, and anti-CD38 antibodies, and are increasingly being used in earlier lines of therapy. However, the availability of multiple BCMA-targeted approaches, including CAR-T-cell therapy, bispecific antibodies, and belantamab mafodotin, has made treatment selection increasingly complex. In clinical practice, it is important to consider not only efficacy, but also treatment sequence, bridging therapy before CAR-T-cell infusion, effects on subsequent therapies, treatment access, and patient-specific risks. In addition, GPRC5D-targeted therapy and dual-target strategies may provide new options for patients previously treated with BCMA-targeted therapies and for those with extramedullary disease. Long-term management, including infection prevention, hypogammaglobulinemia, prolonged cytopenias, and secondary malignancies, is also becoming increasingly important. This review summarizes the current clinical role of T-cell redirecting therapies in relapsed or refractory multiple myeloma, with a focus on treatment sequencing, extramedullary disease, long-term management, and future directions.
PMID:42951642 | DOI:10.11406/rinketsu.67.1257