Expert Discussion on Earlier Use of Teclistamab-Based Therapy in Relapsed/Refractory Multiple Myeloma

Following the MAJESTEC-3 presentation, the faculty discuss how the trial findings may influence the evolving treatment landscape for relapsed/refractory multiple myeloma (R/R MM). Dr. Harsh Parmar, Dr. Gurbakhash Kaur, Dr. Cesar Rodriguez, and Dr. Prashant Kapoor examine the potential role of earlier teclistamab plus daratumumab therapy while considering its impact on future treatment options, particularly subsequent BCMA-directed CAR-T cell therapy. The panel discusses challenges related to sequencing after prior BCMA exposure, the importance of preserving future therapeutic options, and the need for emerging strategies such as alternative antigen targets and next-generation cellular therapies. Faculty also review practical considerations including infection risk, the role of intravenous immunoglobulin and antimicrobial prophylaxis, patient selection, frailty, caregiver support, and the balance between continuous therapy and time-limited treatment approaches. The discussion concludes that treatment decisions should remain highly individualized, incorporating disease characteristics, patient preferences, access to specialized care, and evolving clinical evidence as the sequencing of BCMA-directed therapies continues to develop in relapsed/refractory multiple myeloma.