Integrating BCMA-directed bispecific antibodies into the treatment paradigm for MM

During the Multiple Myeloma Hub Steering Committee Meeting on May 12, 2026, key opinion leaders met to discuss the integration of B-cell maturation antigen (BCMA)-directed bispecific antibodies (BsAbs) into the treatment paradigm for multiple myeloma (MM). The discussion was led by Miles Prince (Peter MacCallum Cancer Centre, Melbourne, AU) and featured steering committee members Rakesh Popat and Heinz Ludwig. The discussion explored key considerations for patient selection, treatment sequencing, and implementation of BsAb therapy in clinical practice. 

Prince reviews the currently approved BCMA-directed BsAbs and key factors influencing treatment selection, including disease burden, prior therapy, T-cell fitness, patient preferences, and treatment access. Prince also discusses emerging treatment strategies, including combination regimens and earlier-line use of BsAbs, before exploring practical considerations related to dosing, toxicity management, and community-based treatment delivery (Figures 1 and 2). The subsequent discussion focused on expanding access to BsAb therapy, the role of standardized toxicity management pathways, and challenges associated with transitioning patients from specialist centers to community-based care.  

Key points 

• BCMA-directed BsAbs provide an off-the-shelf immunotherapy option for the treatment of MM, with broadly comparable efficacy and safety profiles across currently approved agents.³ 
• Selection of BCMA-directed BsAbs is influenced by multiple factors, including disease burden, treatment urgency, prior therapies, T-cell fitness, patient preferences, and access to treatment.³ 
• The International Myeloma Working Group (IWMG) consensus recommendations suggest, when feasible, CAR T-cell therapy is generally preferred for eligible patients; however, BCMA-directed BsAbs may be particularly valuable for patients requiring rapid treatment initiation or those unable to access CAR T-cell therapy.⁴ 
• Responses to subsequent BCMA-targeted therapies may be less frequent and less durable following prior BCMA-directed treatment, highlighting the importance of considered treatment sequencing.⁴ 
• Combination regimens and earlier-line use of BCMA-directed bispecific antibodies are being investigated with the aim of improving depth and durability of response, although long-term safety considerations remain important.⁵ 
• As BCMA-directed BsAbs move into earlier lines of therapy, further research is needed to better understand toxicity profiles, infection risk, and outcomes in different patient populations.⁵ 
• Step-up dosing and early monitoring are key components of treatment initiation, as cytokine release syndrome and neurotoxicity most commonly occur during the initial treatment period.^1,2 
• The transition of patients from specialist centers to community-based care has the potential to improve access and convenience but requires appropriate infrastructure, training, and multidisciplinary coordination.^1,2 
• Standardized protocols, clear escalation pathways, and patient education are essential to support early recognition and management of treatment-related toxicities in community settings.¹ 
• Expanding access to BCMA-directed bispecific antibodies requires continued collaboration between specialist and community centers to ensure safe and effective delivery of care.¹