Comparing BCMA Bispecific Options and Exploring Combination and Future Strategies

Drs Paul Richardson and Hans Lee compare the three currently available BCMA-directed bispecific antibodies and discuss how differences in administration, logistics, and emerging data influence treatment selection in relapsed or refractory multiple myeloma. While acknowledging the strong efficacy shared across the class, the conversation focuses on practical differentiators, including step-up dosing cadence, feasibility in community settings, and performance in difficult-to-treat subgroups such as patients with high disease burden or extramedullary disease. The faculty also explore the growing role of combination strategies, highlighting how bispecific antibodies may be partnered with immunomodulatory agents, proteasome inhibitors, or CD38-directed monoclonal antibodies to enhance depth and durability of response. Mechanistic considerations around cytopenias and inflammatory marrow effects are reviewed, along with supportive care approaches. Looking ahead, the discussion highlights emerging data on linvoseltamab in earlier-line and consolidation settings, underscoring its potential to expand access to highly active immunotherapy beyond specialized academic centers and into broader real-world practice.