TY - JOUR
T1 - Sequencing BCMA- and GPRC5D-targeting immunotherapies in multiple myeloma
T2 - Practical guidance from the European Myeloma Network
AU - van de Donk, Niels W. C. J.
AU - Moreau, Philippe
AU - San-Miguel, Jesus F.
AU - Mateos, Maria-Victoria
AU - Dimopoulos, Meletios A.
AU - Zweegman, Sonja
AU - Gay, Francesca
AU - Engelhardt, Monika
AU - Mina, Roberto
AU - Zamagni, Elena
AU - Delforge, Michel
AU - Beksac, Meral
AU - Spencer, Andrew
AU - Schjesvold, Fredrik
AU - Driessen, Christoph
AU - Kaiser, Martin
AU - Perrot, Aurore
AU - Wäsch, Ralph
AU - Korst, Charlotte L. B. M.
AU - Broijl, Annemiek
AU - Touzeau, Cyrille
AU - Manier, Salomon
AU - Hajek, Roman
AU - Bila, Jelena
AU - Seval, Guldane C.
AU - O'Dwyer, Michael
AU - Ludwig, Heinz
AU - Fernandez de Larrea, Carlos
AU - Popat, Rakesh
AU - Musto, Pellegrino
AU - Rodriguez-Otero, Paula
AU - Yong, Kwee
AU - Kortüm, Marin
AU - Rasche, Leo
AU - Terpos, Evangelos
AU - Raab, Marc S.
AU - the EMN Guidelines Committee
AU - Boccadoro, Mario
AU - Sonneveld, Pieter
AU - Einsele, Hermann
N1 - Publisher Copyright:
© 2025 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association.
PY - 2025/11/1
Y1 - 2025/11/1
N2 - The treatment landscape of heavily pretreated relapsed/refractory MM has changed considerably in recent years with the introduction of novel BCMA- and GPRC5D-directed immunotherapies, including CAR T-cell therapy, bispecific antibodies (BsAbs), and antibody-drug conjugates (ADCs). Treatment selection and sequencing become increasingly complex with the broad range of therapeutic options. In this review, the European Myeloma Network provides recommendations on how to best incorporate these novel therapies into the present treatment landscape using current evidence. The optimal treatment sequence depends on various patient- and tumor-related features, but also reimbursement and availability issues. In addition, mechanisms underlying relapse (e.g., antigen loss, reduced T-cell fitness, or outgrowth of T-cell resistant clones) dictate the efficacy of sequential BCMA- or GPRC5D-directed immunotherapy. BCMA-targeting BsAbs and ADCs should preferably be avoided prior to CAR T-cell therapy, as some studies have shown that these agents negatively influence clinical outcomes after CAR T-cell therapy. Therefore, we recommend the selection of CAR T-cell therapy first, and BsAbs and/or belamaf later in the disease course, if patients are eligible for CAR T-cell therapy and in case CAR T-cell therapy is available within a short time frame. However, bridging therapy with GPRC5D-directed BsAbs (initiation after apheresis) can be considered to significantly reduce tumor burden, because this was shown to improve the efficacy of consecutive BCMA-directed CAR T-cell therapy. Sequential treatment with agents targeting the same antigen, but with different modes of action, is feasible, but several studies have demonstrated that target switch is a more effective strategy. In addition, there is increasing evidence indicating that the efficacy of sequential use of BsAbs can be improved by creating a BsAb-free interval.
AB - The treatment landscape of heavily pretreated relapsed/refractory MM has changed considerably in recent years with the introduction of novel BCMA- and GPRC5D-directed immunotherapies, including CAR T-cell therapy, bispecific antibodies (BsAbs), and antibody-drug conjugates (ADCs). Treatment selection and sequencing become increasingly complex with the broad range of therapeutic options. In this review, the European Myeloma Network provides recommendations on how to best incorporate these novel therapies into the present treatment landscape using current evidence. The optimal treatment sequence depends on various patient- and tumor-related features, but also reimbursement and availability issues. In addition, mechanisms underlying relapse (e.g., antigen loss, reduced T-cell fitness, or outgrowth of T-cell resistant clones) dictate the efficacy of sequential BCMA- or GPRC5D-directed immunotherapy. BCMA-targeting BsAbs and ADCs should preferably be avoided prior to CAR T-cell therapy, as some studies have shown that these agents negatively influence clinical outcomes after CAR T-cell therapy. Therefore, we recommend the selection of CAR T-cell therapy first, and BsAbs and/or belamaf later in the disease course, if patients are eligible for CAR T-cell therapy and in case CAR T-cell therapy is available within a short time frame. However, bridging therapy with GPRC5D-directed BsAbs (initiation after apheresis) can be considered to significantly reduce tumor burden, because this was shown to improve the efficacy of consecutive BCMA-directed CAR T-cell therapy. Sequential treatment with agents targeting the same antigen, but with different modes of action, is feasible, but several studies have demonstrated that target switch is a more effective strategy. In addition, there is increasing evidence indicating that the efficacy of sequential use of BsAbs can be improved by creating a BsAb-free interval.
UR - https://www.scopus.com/pages/publications/105023984607
U2 - 10.1002/hem3.70260
DO - 10.1002/hem3.70260
M3 - Article
C2 - 41306326
SN - 2572-9241
VL - 9
JO - HemaSphere
JF - HemaSphere
IS - 11
M1 - e70260
ER -