Novel T-cell immunotherapies (chimeric antigen receptor [CAR] T cells and T-cell redirecting bispecific antibodies) are changing the treatment landscape of relapsed or refractory multiple myeloma. In this Review, the European Myeloma Network provides recommendations to optimise both safety and efficacy of T-cell immunotherapy. In patients who are eligible for both CAR T-cell therapy and bispecific antibodies, we recommend using CAR T-cell therapy first due to the high response rate and durable progression-free survival, accompanied by improved quality of life. Furthermore, previous bispecific antibody treatment has a negative effect on the efficacy of CAR T-cell therapy, and there is emerging evidence that suggests that relapse after B-cell maturation antigen-directed CAR T-cell therapy can be effectively managed with bispecific antibodies. Timely referral and planning are crucial before initiating T-cell immunotherapy to optimise treatment selection, conduct adequate diagnostic tests (eg, excluding latent infections), and identify modifiable risk factors to improve clinical outcomes. Supportive care is crucial in all patients receiving T-cell immunotherapy to prevent non-relapse mortality.

1st Department of Medicine Center for Oncology Hematology and Palliative Care Wilhelminen Cancer Research Institute Clinic Ottakring Vienna Austria

Cancer Center Clinica Universidad de Navarra Centro de investigación médica aplicada de la Universidad de Navarra Instituto de Investigación Sanitaria de Navarra Centro de Investigación Biomédica en Red de Cáncer Pamplona Spain

Centre Hospital Universitaire Université de Toulouse Toulouse France; Institut Universitaire du Cancer Toulouse Oncopole Toulouse France

Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Athens Greece

Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Athens Greece; Department of Medicine Korea University Seoul South Korea

Department of Haematology University College London Hospitals NHS Foundation Trust London UK

Department of Hemato oncology University Hospital Ostrava Ostrava Czech Republic; Department of Hemato oncology Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Hematology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Netherlands; Cancer Biology and Immunology Cancer Center Amsterdam Amsterdam Netherlands

Department of Hematology Ankara Liv Hospital Istinye University Ankara Turkey

Department of Hematology Erasmus MC Cancer Institute Rotterdam Netherlands

Department of Hematology Lille University Hospital Lille France

Department of Hematology Oncology and Stem Cell Transplantation Comprehensive Cancer Center Freiburg University of Freiburg Freiburg Germany

Department of Hematology Oslo Myeloma Center Oslo University Hospital Oslo Norway

Department of Hematology The Royal Marsden Hospital London UK; Division of Genetics and Epidemiology The Institute of Cancer Research London UK

Department of Hematology University Hospital Hôtel Dieu Nantes France

Department of Hematology University Hospital Leuven Leuven Belgium

Department of Internal Medicine 2 University Hospital of Würzburg Würzburg Germany

Department of Internal Medicine 5 Heidelberg Myeloma Center Heidelberg University Hospital Heidelberg Germany

Department of Medical Oncology and Hematology HOCH Health Ostschweiz Cantonal Hospital St Gallen St Gallen Switzerland

Department of Precision and Regenerative Medicine and Ionian Area Universitá degli Studi di Bari Aldo Moro Bari Italy; Hematology and Stem Cell Transplantation Unit AOU Consorziale Policlinico Bari Italy

Hospital Clínic de Barcelona IDIBAPS University of Barcelona Barcelona Spain

IRCCS AOU Universitaria di Bologna Istituto di Ematologica Seragnoli Bologna Italy; Department of Medical and Surgical Sciences Università di Bologna Bologna Italy

Malignant Haematology and Stem Cell Transplantation Service Alfred Health Monash University Melbourne VIC Australia

University Division of Hematology AOU City of Health and Science in Turin Turin Italy; Department of Biotechnology and Health Sciences University of Torino Italy

University Hospital of Salamanca IBSAL Cancer Research Center Salamanca Spain

Lancet Haematol. 2025 Oct;12(10):e772. doi: 10.1016/S2352-3026(25)00257-1. PubMed

Citace poskytuje Crossref.org

Exceptional long-term responses from OCEAN and HORIZON trials: melflufen-dexamethasone as an expansion of treatment options for relapsed/refractory multiple myeloma in the era of new immunotherapies?