European Expert Recommendations on Teclistamab Management for Relapsed or Refractory Multiple Myeloma

The global incidence of multiple myeloma (MM) continues to rise. While survival rates for newly diagnosed patients have improved substantially with the introduction of novel therapies, outcomes remain poor for those with triple-class-exposed (TCE) relapsed/refractory MM (RRMM). Recent therapeutic innovations, including chimeric antigen receptor T-cell therapy, antibody-drug conjugates, and bispecific antibodies, offer new effective options for this challenging population. Teclistamab, the first approved B-cell maturation antigen-targeted bispecific antibody, has demonstrated deep and durable responses and an acceptable safety profile in TCE RRMM. Teclistamab is now a recommended treatment from second relapse onwards in patients with TCE RRMM in the 2025 European Hematology Association-European Myeloma Network guidelines. Nevertheless, considering the novelty of this agent and its overall safety profile, there is a need for clear guidance on patient management in routine clinical practice. Here, we aim to provide a comprehensive overview of the clinical profile of teclistamab and expert recommendations on its optimal use in TCE RRMM. We focus on key aspects and considerations needed for patient selection (including special populations such as the elderly, frail individuals, those with extramedullary disease or renal impairment), as well as therapy initiation, and strategies for adverse event prevention, monitoring, and management. Ultimately, this review aims to support physicians in maximizing the therapeutic potential of teclistamab, improving outcomes for patients through tailored, evidence-based management.