Reshaping multiple myeloma treatment: recent breakthroughs

Introduction: The therapeutic landscape of multiple myeloma (MM) is rapidly evolving through advances in immune-based strategies. Bispecific antibodies (BsAbs), chimeric antigen receptor T-cell (CAR-T) therapies, and emerging trispecific antibodies (TsAbs) are reshaping expectations by delivering deep and durable responses even in heavily pretreated disease. Areas covered: Off-the-shelf BsAbs such as teclistamab, elranatamab, and talquetamab show robust activity in triple-class - exposed patients, with earlier use and combination regimens further enhancing response depth. However, challenges remain, including T-cell exhaustion, infection risk, hypogammaglobulinemia, and logistical issues related to step-up dosing and cytokine release syndrome. CAR-T therapies, particularly idecabtagene vicleucel and ciltacabtagene autoleucel, achieve high response rates and rapid MRD negativity, but wider use is limited by manufacturing time, toxicity management, and relapse mechanisms such as antigen loss. Innovations including dual-target CAR-T, armored constructs, and allogeneic platforms aim to improve durability and expand access. MRD assessment has become a biomarker guiding treatment intensity, and duration. In parallel, refined risk stratification -especially for high-risk cytogenetic, functional, and extramedullary disease- helps identify patients who may benefit from early integration of immunotherapies. Expert opinion: Overall, these advances support a shift toward personalized strategy designed to achieve deep remission, reduce toxicity, and approach functional cure in selected patients.