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SOHO 2025 | The transformative impact of immunotherapy in high-risk multiple myeloma
Sundar Jagannath, MD, Tisch Cancer Institute at Mount Sinai, New York, NY, comments on the transformative impact of immunotherapy in multiple myeloma, highlighting the emergence of novel treatments such as bispecific antibodies and CAR T-cells. Dr Jagannath notes that these treatments have overcome traditional high-risk disease markers, such as TP53 deletion, and have enabled patients to achieve long-term remission and measurable residual disease (MRD) negativity. This interview took place at the 13th Annual Meeting of the Society of Hematologic Oncology (SOHO 2025) in Houston, TX.
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Transcript
The excitement in multiple myeloma is basically immuno-oncology. Up until now, we used to say, by molecularly defined high-risk myeloma patient, that there was no real treatment option. You go ahead and give this combination chemotherapy, then they become resistant and every time they relapse, their duration of control of cancer is shorter and shorter. But lo and behold, the immuno-oncology, bispecific antibodies and CAR T-cells, the T-cell redirection therapy have come in...
The excitement in multiple myeloma is basically immuno-oncology. Up until now, we used to say, by molecularly defined high-risk myeloma patient, that there was no real treatment option. You go ahead and give this combination chemotherapy, then they become resistant and every time they relapse, their duration of control of cancer is shorter and shorter. But lo and behold, the immuno-oncology, bispecific antibodies and CAR T-cells, the T-cell redirection therapy have come in. They are dramatically producing overall response rates of 70% in these patients and CAR-T, especially cilta-cel, had a 97% response rate. And in many of these patients, the responses are deep complete remission with no measurable disease or MRD negative and PET CT negative. This is being achieved in a substantial proportion of patients in relapse and refractory multiple myeloma. And not only that we found that what we used to say like deletion TP53 it’s known to be a bad high-risk disease marker, not only in myeloma, in lymphoma, in leukemia. And it turns out this immuno-oncological method like bispecific, trispecific or CAR-T completely overcomes that and these patients go into remission and stay in remission for a long period of time. They go into MRD negative. This is an unprecedented time. That’s why immuno-oncology is very important. More recently, in multiple myeloma, we have had two BCMA-directed bispecific antibody had been approved. One of them is teclistamab. Another one is elranatamab. And this year, there was a third drug, linvoseltamab, was also approved. And all these drugs have an overall response rate of 70% and they have a complete remission, MRD negativity. There was a comparison that was done. You know, there was not a randomized trial, but there was a matched pairing analysis of these reported results to see how they all stack out. There were a couple of advantages for linvoseltamab. Number one, they are done weekly and during the step-up doses and their hospitalization is only for 24 hours or less. That is a major advantage over the others. And it also turns out it produces deep responses. So there was a matched comparison done. But it is not a randomized trial showing that this is another antibody in this area, which is also important to be brought forth. And we are happy that it got approved.
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