BCMA CAR T-Cell Therapy Improves OS Vs Teclistamab in Multiple Myeloma

BCMA-directed CAR T-cell therapy demonstrated superior overall survival (OS) outcomes, albeit with a higher incidence of immune-mediated toxicities, compared with teclistamab-cqyv (Tecvayli), according to a poster presentation on findings from a retrospective cohort study at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.¹

Regarding all-cause mortality at 2 years between patients with received CAR T-cell therapy and those who received teclistamab, data showed an HR of 0.61 (95% CI, 0.43-0.87; P = .005). Additionally, the incidence of cytokine release syndrome (CRS) appeared to be higher with CAR T-cell agents compared with teclistamab (HR, 1.48; 95% CI, 1.12-1.96; P = .003). Findings also showed that immune effector cell-associated neurotoxicity syndrome (ICANS) occurred more frequently with CAR T-cell therapy vs teclistamab (HR, 2.02; 95% CI, 1.20-3.41; P = .007).

“BCMA CAR-T therapy was associated with improved 2-year [OS] compared with teclistamab, although with higher immune-related toxicities in [multiple myeloma],” Junmin Song, MD, MS, from the Department of Medicine at Jacobi Medical Center of Albert Einstein College of Medicine, wrote with coauthors in the poster.¹ “Prospective studies comparing BCMA CAR-T therapy and bispecific antibodies are needed… Longer follow-up is needed to evaluate long-term survival outcomes and toxicities.”

The investigators also noted that future research may help define optimal sequencing strategies for these CAR T-cell therapies and bispecific antibodies while improving patient selection for anti-BCMA therapy.

Regarding the study’s background, the investigators noted that BCMA-directed agents have improved outcomes in relapsed/refractory multiple myeloma, although data on the real-world use of teclistamab and anti-BCMA CAR T-cell therapies remain limited. In a previous study published in Haematologica, Song and colleagues reported that patients who received CAR T-cell therapies experienced a lower risk of all-cause mortality compared with those treated with teclistamab at 3 months (HR, 0.36; 95% CI, 0.20-0.65), 6 months (HR, 0.51; 95% CI, 0.32-0.81), and 1 year (HR, 0.53; 95% CI, 0.35-0.78).² However, these improvements in survival came with a higher risk of CRS at 1 month (HR, 1.47; 95% CI, 1.10-1.97) and 1 year (HR, 1.40; 95% CI, 1.06-1.84).² The study investigators noted that the follow-up duration for the previous study was limited due to the recent approvals of the evaluated agents.

Investigators of this updated retrospective cohort study assessed 2-year OS and immune-related toxicities using information from the TriNetX US Collaborative Network. Patients with multiple myeloma who received BCMA-directed CAR T-cell therapy with idecabtagene vicleucel (ide-cel; Abecma) or ciltacabtagene autoleucel (cilta-cel; Carvykti) or teclistamab from 2021 to 2023 were eligible for enrollment on the study protocol. Those who received both CAR T-cell therapy and teclistamab were excluded from the analysis, as were patients who received other bispecific antibodies like elranatamab-bcmm (Elrexfio), talquetamab-tgvs (Talvey), or linvoseltamab-gcpt (Lynozyfic).

The analysis used 1:1 propensity score matching to balance baseline characteristics per ICD-10 and TriNetX codes. The primary end point was 2-year OS. Secondary end points included the incidence of CRS and ICANs. Investigators estimated HRs using Cox proportional hazard models.

The mean age at index was 65.2 ± 8.3 years among 227 patients who received CAR T-cell therapy and 65.7 ± 10.1 years among 227 patients who received teclistamab. Regarding other matched baseline characteristics in the CAR T-cell therapy and teclistamab groups, most patients were male (54.2% vs 52.9%) and White (74.0% vs 74.9%). Additionally, most patients in each group had prior dexamethasone (93.0% vs 92.5%), prior lenalidomide (Revlimid; 55.1% vs 55.9%), and prior pomalidomide (Pomalyst; 57.3% vs 58.2%). Toxicities noted at baseline across each group included hypertensive diseases (70.5% vs 72.2%), neutropenia (65.2% vs 67.4%), and unspecified anemia (59.5% vs 58.6%).

References

1. Song J, Li WF, Li Y, et al. Updated two-year overall survival and toxicity outcomes of BCMA CAR-T therapy compared with teclistamab in multiple myeloma. J Clin Oncol. 2026;44(suppl 16):7527. doi:10.1200/JCO.2026.44.16_suppl.7527
2. Song J, Chiang CH, Esagian S, et al. Teclistamab versus B-cell maturation antigen-targeting chimeric antigen receptor T-cell therapy in multiple myeloma: a comparative effectiveness analysis. Haematologica. 2025;110(10):2498-2502. doi:10.3324/haematol.2024.287215