Relapsed/Refractory Multiple Myeloma: Debate — Treatment Selection Between CAR T-Cell and Bispecific Approaches in Second-Line Disease

Dr. Thomas Martin opens the second section, the face-off debate, and introduces the first debate question on how clinicians should approach treatment selection between CAR T-cell therapy and bispecific antibody-based approaches in second-line disease. Team Myeloma Mavericks argues the CAR T-cell-first position, emphasizing demonstrated curative potential, deep and durable responses, one-time treatment, and freedom from continuous therapy and its associated infection burden. Team Myeloma Masters rebuts by positioning the bispecific data as comparable in efficacy while offering a more favorable safety profile, broader accessibility, and lower early caregiver demands, along with off-the-shelf availability for patients whose disease is progressing quickly. The moderated discussion turns to patient fitness and candidacy for CAR T-cell therapy, including real-world evidence supporting its use in older patients and those with renal impairment and the narrow subset of truly frail patients better suited to a bispecific, the management of rapidly progressive disease with holding and bridging therapy, and the value of a holding-therapy window that lets patients absorb information and defer the CAR T-cell decision, with the treatment-free interval highlighted as a central advantage.