Relapsed/Refractory Multiple Myeloma: MajesTEC-3 and the Bispecific Antibody Approach in Earlier-Relapse Disease

Segment opens with the closing moments of the CAR T-cell therapy quality-of-life argument before Dr. Thomas Martin transitions to the second abstract review. Team Myeloma Masters presents MajesTEC-3, reviewing teclistamab plus daratumumab versus standard regimens in relapsed/refractory multiple myeloma across earlier lines of therapy. The presentation highlights the largely daratumumab-naive, predominantly lenalidomide-refractory population and the study's efficacy signal, including a marked progression-free survival benefit, high overall response and complete response rates, substantial MRD negativity, and an early overall survival advantage. The cross-team debate, moderated by Dr. Martin, examines how applicable the trial's daratumumab-naive population is to US practice, whether high-risk cytogenetics should steer selection toward CAR T-cell therapy versus a bispecific approach, the role and duration of IVIG supportive care, and the central safety trade-off between high-grade infections with bispecific antibodies and immune effector cell-associated enterocolitis, delayed neurotoxicity, Parkinsonism, and prolonged cytopenias with CAR T-cell therapy. The discussion extends into cytopenia management, growth factor use, and real-world access disparities between academic and community centers for both modalities, all framed within fair-balance considerations.