Multicenter analysis of prognostic factors for efficacy and safety of teclistamab and elranatamab in multiple myeloma

Bispecific antibodies (BsAbs) targeting BCMA such as teclistamab and elranatamab show remarkable efficacy in relapsed or refractory multiple myeloma (rrMM), but real-world data on treatment failure and severe infections are limited. A retrospective study at 10 centers in France evaluated the efficacy, infection rates, and adverse events of teclistamab (n=148) and elranatamab (n=53) therapy for rrMM. Over a median follow-up of 13 months, the median progression-free survival was 17.9 months in the BsAb cohort (not reached for teclistamab; 9.3 months for elranatamab). Grade ≥ 3 infections were significantly higher in BsAb-treated patients than in 162 matched controls (98.2/100 patients-years versus 27.1/100 patient-years; p<0.001). Intensive care admissions were more frequent among BsAb patients than controls. Teclistamab showed superior 12-months OS (73.4% versus 53.9%; p<0.05). Key adverse events included cytokine release syndrome (50.2%; 2% grade ≥3) and neurotoxicity (8.5%; 5.9% grade ≥ 3). The authors conclude that BsAb therapy improves rrMM outcomes, but increases severe infection risk, necessitating proactive management.