Sequencing, Real-World Evidence, and Unmet Needs: Key Immunotherapy Insights From ASH 2025 in Multiple Myeloma

EP: 1.iMMagine-1: Anito-Cel Shows Efficacy in R/R Multiple Myeloma

EP: 2.Safety and Outpatient Potential of Anito-Cel in Multiple Myeloma

EP: 3.Exploring CAR T-Cell Therapy Efficacy in Earlier Vs Later Lines of Therapy

EP: 4.Linking T-Cell Composition to CAR T Efficacy in Multiple Myeloma

EP: 5.Sequencing CAR T-Cell Therapy in the Evolving Myeloma Treatment Landscape

EP: 6.Teclistamab-Daratumumab Outperforms Standard of Care for R/R Multiple Myeloma

EP: 7.MajesTEC-3 and the Future of Combination Regimens in Multiple Myeloma

EP: 8.Early Data Show Feasibility of In Vivo CAR T Therapy in Multiple Myeloma

EP: 9.The Promise of In Vivo CAR T: Expanding Access Through Off-the-Shelf Innovation

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EP: 10.Sequencing, Real-World Evidence, and Unmet Needs: Key Immunotherapy Insights From ASH 2025 in Multiple Myeloma

Krina Patel, MD, MSc, associate professor in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, highlights immunotherapy data sets from ASH 2025 that are shaping how clinicians think about sequencing, patient selection, and unmet needs in multiple myeloma. A major theme is the growing body of real-world evidence examining outcomes based on treatment order, particularly the sequencing of CAR T-cell therapy and bispecific antibodies. Emerging data suggest that patients who receive CAR T therapy before bispecifics may experience improved overall survival compared with those treated with bispecifics first, reinforcing the importance of strategic sequencing even as these therapies move into earlier lines of treatment.

The conversation also emphasizes the value of real-world studies that include patients traditionally excluded from clinical trials. Presentations focused on high-risk and understudied populations, such as those with central nervous system involvement or plasma cell leukemia, provided important insights into how novel immunotherapies perform outside tightly controlled trial settings. Notably, data suggest that BCMA-directed therapies may be less effective in patients with active plasma cell leukemia, potentially due to higher levels of soluble BCMA. In contrast, non-BCMA–targeted approaches, such as the GPRC5D-directed bispecific talquetamab, appear to produce more favorable outcomes in this population, highlighting the need for disease-specific therapeutic strategies.

These findings underscore a broader shift toward more personalized immunotherapy selection based on disease biology rather than a one-size-fits-all approach. By better understanding how different subgroups respond, clinicians may be able to improve both eligibility and outcomes for patients who have historically had limited treatment options.

The interview concludes by identifying one of the field’s most pressing unmet needs: determining when and how therapy can be safely stopped. As deeper and more durable responses—including sustained minimal residual disease negativity—become increasingly common, there is growing interest in fixed-duration or de-escalation strategies. Reducing treatment intensity could lower costs, improve quality of life, and potentially maintain long-term disease control, marking the next major challenge in the evolving myeloma treatment landscape.