Symposium | Real-world insights and clinical experience with BCMA‑directed therapies

On December 17, 2025, the Multiple Myeloma Hub held a virtual symposium, titled Integrating novel BCMA-directed therapies into clinical practice: Insights from real-world experience. During the symposium, Gordon Cook, University of Leeds, UK, delivered a presentation covering real-world insights and clinical experience with BCMA-directed therapies. 

In this presentation, Cook examined how populations enrolled in pivotal trials of B-cell maturation antigen (BCMA)-directed therapies compare with patients treated in routine clinical practice. Key differences were highlighted, including age, performance status, comorbidities, and prior treatment exposure. Cook presented data for bispecific antibodies and CAR T-cell therapies, focusing on efficacy and safety outcomes in real-world populations, as well as the impact of prior BCMA exposure on response and durability of response. Real-world experience with management of adverse events, particularly infections and ocular complications, was also discussed, as were the implications of these findings for treatment sequencing as BCMA-directed therapies move into earlier lines of therapy. 

Key points 

• Patients enrolled in pivotal trials of BCMA-directed therapies are typically younger, fitter, and have fewer comorbidities than those treated in routine clinical practice, which may limit the applicability of trial outcomes to real-world settings.^1–8
• Real-world analyses suggest that a substantial proportion of patients treated in clinical practice would not have met eligibility criteria for pivotal trials of BCMA-directed therapies, most commonly due to older age, poorer performance status, or impaired organ function (Figure 1).^1–8 

• Real-world efficacy outcomes with BCMA-directed bispecific antibodies and CAR T-cell therapies appear largely comparable with those reported in clinical trials, despite treatment of broader patient populations .^1–4,7,8
• Prior exposure to BCMA-directed therapies has been associated with reduced response rates and shorter progression-free survival in real-world datasets, highlighting the potential impact of prior BCMA-exposure on subsequent treatment outcomes.^1,3,7
• Real-world safety data suggest that rates of cytokine release syndrome and neurotoxicity are generally similar to, or slightly lower than, those reported in clinical trials, although infections remain a clinically significant complication requiring close monitoring and supportive care.^1–4,7,8
• Experience from real-world use of belantamab mafodotin monotherapy indicates that flexible, patient-specific dosing and treatment delays may help manage ocular adverse events while maintaining efficacy (Figure 2).^9–11

• As BCMA-directed therapies move into earlier lines of treatment, real-world data will have an increasingly important role in informing treatment sequencing, strategies to mitigate adverse events, and optimization of long-term patient outcomes.⁷ 

This independent educational activity was supported by GSK. All content was developed independently by SES in collaboration with the faculty. The funder was allowed no influence on the content of this activity.