Bringing Bispecifics Earlier: Frontline and Maintenance Use in Newly Diagnosed Myeloma

This segment explores the emerging role of bispecific antibodies in newly diagnosed multiple myeloma (NDMM) and how these therapies may move beyond their current use in heavily pretreated disease. Faculty review early-phase data evaluating bispecific antibodies in frontline combination regimens and in post-transplant maintenance settings. The discussion highlights the potential advantages of introducing these agents earlier in the disease course, including the possibility of achieving deeper responses and higher rates of MRD negativity when disease burden is lower and T-cell function may be more intact.

Panelists consider how these approaches may differ between transplant-eligible and transplant-ineligible populations, and whether bispecific therapies could offer a steroid-sparing or chemotherapy-sparing strategy for patients who have difficulty tolerating proteasome inhibitors or prolonged dexamethasone exposure.

The discussion also addresses potential trade-offs associated with earlier bispecific use, including infection risk, the need for IVIG and antimicrobial prophylaxis, and the lack of mature phase 3 data directly comparing bispecific-based approaches with established standards such as quad-based induction followed by transplant. Overall, the segment examines how the introduction of bispecific antibodies in frontline and maintenance settings could influence future treatment strategies in NDMM.