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Opinion|Videos|January 23, 2026

BCMA Directed CAR T Constructs and Their Clinical Implications in Multiple Myeloma

Author(s)Krina Patel, MD, MSc , Noopur Raje, MD, Gurbakhash Kaur, MD

Panelists discuss how differences in BCMA-directed CAR T constructs (including binding configuration and expansion kinetics) can influence toxicity timing, monitoring needs, and real-world product selection.

Episodes in this series

3 experts are featured in this series

EP. 1 Evolving Evidence for CAR T-Cell Therapy in Relapsed or Refractory Multiple Myeloma

3 experts are featured in this series

EP. 2 BCMA Directed CAR T Constructs and Their Clinical Implications in Multiple Myeloma

3 experts are featured in this series

EP. 3 Determining Eligibility for Second Line vs Third Line CAR T-Cell Therapy in Multiple Myeloma

This segment reviews the structural design and functional differences between the two approved BCMA directed CAR T-cell therapies, idecabtagene vicleucel and ciltacabtagene autoleucel, and how these features influence their clinical use in relapsed or refractory multiple myeloma. Dr. Raje explains that both therapies target B-cell maturation antigen and use a 4-1BB costimulatory domain, but they differ in antigen binding configuration. Ciltacabtagene autoleucel incorporates dual epitope binding, which enhances binding strength and may contribute to deeper and more sustained responses. Idecabtagene vicleucel uses a single epitope binding domain and typically expands earlier after infusion. These biologic distinctions correlate with differences in timing of cytokine release syndrome, neurotoxicity risk, and decisions regarding inpatient versus outpatient management. Understanding construct design and expansion kinetics helps clinicians anticipate toxicity patterns and optimize product selection and monitoring strategies for individual patients with multiple myeloma.

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