Sequencing BCMA-Directed Therapies Across Modalities and Lines of Relapse

Drs Paul Richardson and Hans Lee discuss the evolving and often complex decisions around sequencing BCMA-directed therapies in multiple myeloma. Drawing on real-world experience, the faculty highlight that while conventional guidance has often favored CAR T-cell therapy before bispecific antibodies, this paradigm is increasingly nuanced. The conversation explores how differences in administration, tolerability, durability of response, and logistical requirements shape individualized treatment planning. Antibody-drug conjugates are positioned as an important option, particularly in settings where access to CAR T-cell therapy or bispecific antibodies remains limited. Dr Lee emphasizes the importance of aligning sequencing decisions with patient preferences, institutional capabilities, and disease kinetics, while acknowledging that emerging data in earlier-line and even frontline settings are likely to further reshape current algorithms. Together, the speakers underscore that the growing number of highly effective BCMA-targeted modalities represents a positive challenge for clinicians, requiring thoughtful, patient-centered sequencing strategies as evidence continues to evolve.