Debate: CAR-T Cell Therapy Versus BCMA Bispecific Antibodies in Relapsed/Refractory Multiple Myeloma

The program transitions to the first FACE-OFF debate, where the faculty discuss whether CAR-T cell therapy or BCMA bispecific antibodies should be prioritized as BCMA-directed therapies move into earlier lines of treatment for relapsed/refractory multiple myeloma (R/R MM). Dr. Cesar Rodriguez argues in favor of a CAR-T–first approach, emphasizing the potential for deep, durable responses, treatment-free intervals, and long-term disease control, while discussing the importance of preserving CAR-T efficacy through appropriate sequencing. Dr. Prashant Kapoor presents the opposing perspective, highlighting the impressive efficacy of teclistamab-based regimens, the growing movement toward fixed-duration bispecific therapy, and the broader accessibility of off-the-shelf treatments. During the discussion, both teams debate patient selection, quality of life, toxicity profiles, infection risk, cost-effectiveness, access to care, and emerging therapies targeting alternative antigens. The debate concludes that although both treatment strategies offer meaningful clinical benefits, the optimal sequencing of BCMA-directed therapies remains an active area of investigation requiring individualized decision-making and additional comparative evidence in relapsed/refractory multiple myeloma.