Innovative Treatment Strategies for Multiple Myeloma: Car T-cell Therapy, Bispecific Antibodies, AND Beyond

Multiple myeloma (MM) remains largely incurable despite advances in proteasome inhibitor, immunomodulatory drug, and anti-CD38 antibody therapies. Recent years have seen the advent of revolutionary immunotherapies – notably CAR T-cells, bispecific T-cell engagers, monoclonal antibodies (MoAbs), and antibody–drug conjugates (ADCs) – that target myeloma cells in novel ways. These modalities have produced unprecedented response rates in heavily pretreated patients but also introduce unique toxicity and cost challenges. For example, BCMA-directed CAR T-cell products yield high overall response rates (e.g. ORR ~70–90%) with deep remissions, and the BCMA×CD3 bispecific teclistamab achieves ORRs ~63–67% in triple-class refractory MM. Daratumumab and isatuximab (anti-CD38 MoAbs) have been integrated into frontline regimens to deepen responses, while the anti-BCMA ADC belantamab mafodotin has shown ~32% ORR albeit with notable ocular toxicity. This review summarizes current standard treatments and focuses on innovative approaches – including their clinical trial results, safety profiles, and practical challenges – highlighting ongoing research directions for the hematology community.

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