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Opinion|Videos|May 6, 2026

Sequencing CAR-T and Bispecifics in Early Relapse Multiple Myeloma

Author(s)Luciano Costa, MD , Muhamed Baljevic, MD, Carol Ann Huff, MD

Fact checked by: Justin Mancini

Episodes in this series

EP. 1 Defining Early Relapse and Treatment Selection in Multiple Myeloma

EP. 1 Defining Early Relapse and Treatment Selection in Multiple Myeloma

EP. 2 Unmet Needs in Early Relapse Multiple Myeloma

EP. 2 Unmet Needs in Early Relapse Multiple Myeloma

EP. 3 Role of Bispecific Antibodies in Multiple Myeloma

EP. 3 Role of Bispecific Antibodies in Multiple Myeloma

EP. 4 Interpreting MajesTEC-3 Efficacy in Multiple Myeloma

EP. 4 Interpreting MajesTEC-3 Efficacy in Multiple Myeloma

EP. 5 Subgroup Insights in Early Relapse Multiple Myeloma

EP. 5 Subgroup Insights in Early Relapse Multiple Myeloma

EP. 6 Safety Considerations for Bispecific Antibodies in Multiple Myeloma

EP. 6 Safety Considerations for Bispecific Antibodies in Multiple Myeloma

EP. 7 Managing Toxicities of Bispecific Antibodies in Multiple Myeloma

EP. 7 Managing Toxicities of Bispecific Antibodies in Multiple Myeloma

EP. 8 Mechanistic Rationale and Combination Strategies in Multiple Myeloma

EP. 8 Mechanistic Rationale and Combination Strategies in Multiple Myeloma

A panel of experts gathered to discuss the landscape of care in early-relapse multiple myeloma, new phase 3 data, and select patient cases.

EP. 9 Discussing Proper Utilization of BCMA Bispecifics in Early Relapse Multiple Myeloma

EP. 10 Positioning Bispecific Therapy in Early Relapse Multiple Myeloma

EP. 10 Positioning Bispecific Therapy in Early Relapse Multiple Myeloma

EP. 11 Case-Based Sequencing Decisions in Early Relapse Multiple Myeloma

EP. 11 Case-Based Sequencing Decisions in Early Relapse Multiple Myeloma

EP. 12 Sequencing CAR-T and Bispecifics in Early Relapse Multiple Myeloma

EP. 12 Sequencing CAR-T and Bispecifics in Early Relapse Multiple Myeloma

EP. 13 Risk Stratification and Shared Decision-Making in Early Relapse Multiple Myeloma

EP. 13 Risk Stratification and Shared Decision-Making in Early Relapse Multiple Myeloma

In this segment on early relapse multiple myeloma, Luciano Costa raises a critical and ongoing debate regarding optimal sequencing of BCMA-directed therapies. He highlights current clinical observations suggesting that patients who receive CAR-T therapy first may still respond to subsequent bispecific antibodies, whereas outcomes appear less favorable when the sequence is reversed. Muhamed Baljevic agrees that existing data support prioritizing CAR-T therapy in eligible patients, but emphasizes that this paradigm may evolve. He discusses how findings from MajesTEC-3 reflect more flexible and de-escalated dosing strategies for bispecific antibodies, which could influence T-cell fitness, exhaustion, and subsequent treatment responsiveness. Dr. Baljevic also notes that real-world practice increasingly incorporates dose adjustments based on depth of response and tolerability. Overall, this discussion underscores that sequencing decisions in multiple myeloma are not yet definitive and will likely evolve as new data and treatment strategies continue to emerge.

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