Incorporating the Next Generation of Immunotherapies Into the Treatment of Multiple Myeloma

Immunotherapies have recently changed the treatment landscape of multiple myeloma (MM). CAR T cells and T-cell-redirecting bispecific antibodies (BsAbs) yield impressive responses and extend survival in patients with relapsed/refractory MM. There are now 2 BCMA-directed CAR T-cell products and 4 BsAbs (3 targeting BCMA, 1 targeting GPRC5D) currently approved by the FDA for relapsed/refractory MM, in which they demonstrated considerable efficacy. These drugs are now being evaluated in early treatment settings, including as part of frontline regimens for newly diagnosed MM. Importantly, administration of CAR T-cell therapy and BsAbs necessitate careful attention to unique toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenias, and heightened infection risk. This review summarizes the current landscape of immunotherapy in MM, including perspectives on sequencing CAR T-cell therapy and BsAbs. It also discusses ongoing clinical trials evaluating immunotherapy in new combinations and treatment contexts. Immunotherapies have become a key component of the MM therapeutic armamentarium and are poised to assume an even larger role in the coming years.