Dr Chari on Navigating CAR T, Bispecifics, and Other Treatment Approaches in R/R Myeloma

BCMA[-directed therapy] is beating SOC, and that’s a big message to get across.

Ajai Chari, MD, a professor of medicine and director of the Multiple Myeloma Program at the University of California, San Francisco, detailed treatment navigation in relapsed/refractory multiple myeloma in the era of CAR T-cell therapies and bispecific antibodies, as discussed by experts during the 2026 Bridging the Gaps in Leukemia, Lymphoma, and Multiple Myeloma Meeting.

Chari began by explaining that BCMA-targeted therapies have been consistently outperforming standard-of-care (SOC) treatments in phase 3 trials for patients with relapsed/refractory multiple myeloma, including studies such as KarMMa-3 (NCT03651128) and CARTITUDE-4 (NCT04181827) for CAR T-cell therapy, DREAMM-7 (NCT04246047) and DREAMM-8 (NCT04484623) for antibody-drug conjugates (ADCs), and MajesTEC-3 (NCT05083169) for bispecific antibodies. Importantly, these trials did not compare new therapies against outdated approaches, but rather against strong modern SOCs, reinforcing the growing role of BCMA-directed treatment strategies, Chari said.

A key message from Chari is that these therapies should be introduced earlier in the treatment course whenever possible. In particular, CAR T-cell therapy should be discussed and considered early, with timely patient referral to specialized centers. Chari noted concern that prior exposure to other BCMA-directed therapies, such as bispecific antibodies or ADCs, could negatively influence later CAR T-cell effectiveness. Because of this, treatment sequencing decisions should be carefully evaluated before ruling out CAR T-cell therapy.

He also addressed treatment selection after progression on a BCMA-directed therapy. Chari explained that patients may benefit from switching to therapies aimed at different targets, such as GPRC5D, with agents like talquetamab-tgvs (Talvey) and other investigational therapies representing promising options.

Finally, he identified infection prevention as a critical component of care. Since BCMA-targeted therapies eliminate both malignant and healthy plasma cells, patients face increased infection risk. Chari stressed the importance of intravenous immunoglobulin support, recommending it for at least 6 months after CAR T-cell therapy and often for prolonged periods in patients receiving BCMA-directed bispecific antibodies.