The management of multiple myeloma (MM) is evolving with the advent of T-cell redirecting therapies (TCRT), such as chimeric antigen receptor T (CAR T)-cell therapies and bispecific T-cell engagers (TCEs). The International Myeloma Working Group (IMWG) Immunotherapy Committee has provided recommendations on optimizing these therapies for relapsed or refractory multiple myeloma. The growing number of TCRT options, clinical trials, and real-world evidence highlights the need for further evaluation of how these therapies impact tumor biology and immune response. Additionally, guidance is needed on sequencing these therapies to maximize efficacy and safety.

The IMWG Immunotherapy Committee convened a panel of experts in March 2024 to review existing data and provide recommendations for TCRT sequencing in MM. Their analysis included evidence from prospective trials and real-world series, resulting in nine key recommendations on the optimal use of TCRTs. These include guidance on the timing of therapies, washout periods, and considerations for bridging therapy, as well as the sequence of B-cell maturation antigen-targeted therapies following CAR T-cell or TCE treatments. The panel’s findings aim to enhance patient outcomes by addressing factors like disease progression, prior treatments, and the potential impact of different TCRT agents in sequence.

Reference: Costa LJ, Banerjee R, Mian H, et al. International myeloma working group immunotherapy committee recommendation on sequencing immunotherapy for treatment of multiple myeloma. Leukemia. 2025;39(3):543-554. doi: 10.1038/s41375-024-02482-6.