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Review
. 2025 Aug;12(8):e635-e649.
doi: 10.1016/S2352-3026(25)00117-6. Epub 2025 Jun 25.

Optimising T-cell immunotherapy in patients with multiple myeloma: practical considerations from the European Myeloma Network

Affiliations
Review

Optimising T-cell immunotherapy in patients with multiple myeloma: practical considerations from the European Myeloma Network

Niels W C J van de Donk et al. Lancet Haematol. 2025 Aug.

Abstract

Novel T-cell immunotherapies (chimeric antigen receptor [CAR] T cells and T-cell redirecting bispecific antibodies) are changing the treatment landscape of relapsed or refractory multiple myeloma. In this Review, the European Myeloma Network provides recommendations to optimise both safety and efficacy of T-cell immunotherapy. In patients who are eligible for both CAR T-cell therapy and bispecific antibodies, we recommend using CAR T-cell therapy first due to the high response rate and durable progression-free survival, accompanied by improved quality of life. Furthermore, previous bispecific antibody treatment has a negative effect on the efficacy of CAR T-cell therapy, and there is emerging evidence that suggests that relapse after B-cell maturation antigen-directed CAR T-cell therapy can be effectively managed with bispecific antibodies. Timely referral and planning are crucial before initiating T-cell immunotherapy to optimise treatment selection, conduct adequate diagnostic tests (eg, excluding latent infections), and identify modifiable risk factors to improve clinical outcomes. Supportive care is crucial in all patients receiving T-cell immunotherapy to prevent non-relapse mortality.

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Conflict of interest statement

Declaration of interests NWCJvdD: received research support from Janssen, Amgen, Celgene, Novartis, Cellectis, and BMS, and serves on advisory boards for Janssen, Amgen, Celgene, BMS, Sanofi, Takeda, Roche, Novartis, Bayer, Adaptive, Galapagos, Kite Pharma, Merck, Pfizer, AbbVie, and Servier, all paid to his institution. PMo: served on advisory boards for, and received honoraria from, Janssen, BMS, Amgen, Takeda, AbbVie, Sanofi, and Pfizer. JFSM: served on advisory boards for Abbvie, Amgen, BMS, Celgene, Roche, GSK, HaemaLogiX, Johnson & Johnson, KaryoPharm, Merck, Novartis, Pfizer, Regeneron, Sanofi-Aventis, Takeda, and SecuraBio. M-VM: served on advisory boards for Amgen, Bristol Myers Squibb, Celgene, GSK, Janssen, Kite Pharma, Oncopeptides, Pfizer, Roche, Sanofi, and Stemline, and is a speaker bureau member for Janssen. MAD: received honoraria from participation in advisory boards and satellite symposia from Amgen, Sanofi, Regeneron, Menarini, Takeda, GSK, BMS, Janssen, BeiGene, Swixx, and AstraZeneca. SZ: received research support from Janssen and Takeda, and serves on advisory boards for Janssen, BMS, Sanofi, Takeda, Oncopeptides, and GSK, all paid to her institution. FG: served on advisory boards and received honoraria from Janssen, BMS, Celgene, Amgen, Sanofi, Takeda, AstraZeneca, Kyte, Pfizer, Roche, Abbvie, and Menarini. ME: provided advisory support to Amgen, GSK, Janssen, Stemline, Oncopeptides, Pfizer, Sanofi, Takeda, and BMS. RM: consulted and served on advisory boards for Johnson & Johnson, Pfizer, BMS, Amgen, Takeda, Sanofi, GSK; received honoraria from Johnson & Johnson, Pfizer, Abbvie, BMS, Amgen, Takeda, Sanofi, GSK, Menarini-Stemline; and received travel support from Pfizer, Johnson & Johnson, and Sanofi. EZ: has received honoraria and served on advisory boards for Janssen, Amgen, Sanofi, BMS, Pfizer, Menarini-Stemline, and Oncopeptides. MD: has received speaker fees and consultancy honoraria from Amgen, BMS, GSK, Janssen, Roche, Sanofi, and Stemline. MB: served on advisory boards and was a speaker's bureau member for Janssen, BMS, Menarini Stemline, Sanofi, Pfizer, Takeda, and GSK. AS: had a consulting role and served on advisory boards for BMS, Celgene, Janssen, Sanofi, Haemalogix, Antengene, Celltrion, Pfizer; has received research funding from BMS, Celgene, Janssen, Haemalogix, Antengene; and has received honoraria from BMS, Celgene, Janssen, Sanofi, Haemalogix, Antengene, and Pfizer. FS: had consulting role and served on advisory boards for GSK, BMS, Janssen, Oncopeptides, Sanofi, Galapagos, Pfizer, Johnson & Johnson, and has received honoraria from Amgen, BMS, Takeda, Abbvie, Johnson & Johnson, Sanofi, Pfizer, GSK, Menarini, and Regeneron. CD: had consulting role, served on advisory boards, and was a speaker's bureau member for BMS, Johnson & Johnson, Amgen, Novartis, and GSK. MK: had a consulting role and served on advisory boards for Abbvie, BMS, Celgene, GSK, Janssen, Pfizer, Poolbeg, Regeneron, Takeda; has received research funding from BMS, Celgene, Janssen; and has received honoraria from Abbvie, Janssen, and GSK. AP: received honoraria from, had a consulting role, and served on advisory boards for Abbvie, Adaptive, Amgen, BMS, GSK, Janssen, Menarini Stemline, Pfizer, Sanofi, and Takeda. RW: had a consulted role and received honoraria from Abbvie, Alexion, Amgen, BMS, Johnson & Johnson, Kite Pharma, Gilead, Novartis, Pfizer, Sanofi, Takeda, and has received research funding from Johnson & Johnson and Sanofi. AB: served on advisory boards and was a speaker's bureau member for BMS, Johnson and Johnson, Amgen, and Sanofi. CT: served on advisory boards for Amgen, BMS, GSK, Johnson & Johnson, Pfizer, Sanofi, Takeda, and Abbvie; has received honoraria from Amgen, BMS, GSK, Johnson & Johnson, Pfizer, Sanofi, Takeda, and Abbvie; has received research funding from GSK, Sanofi; and has received travel expenses from Johnson & Johnson, Pfizer, and Sanofi. SM: served on advisory boards for Abbvie, Adaptive Biotechnology, Amgen, Celgene, BMS, GSK, Janssen Pharmceuticals, Kite Pharma, Novartis, Pfizer, Regeneron, Roche, Sanofi, and Takeda. RH has consulted for Takeda, Janssen, Amgen, Celgene, AbbVie, BMS, PharmaMar, and Novartis; has received honoraria from Takeda, Janssen, Amgen, Celgene, BMS, PharmaMar, and Novartis; and has received research funding from Takeda, Janssen, Amgen, Celgene, BMS, and Novartis. HL: has received research funding from Sanofi and Amgen, and was a speaker's bureau member and served on advisory boards for Pfizer, Sanofi, Amgen, Janssen, GSK, Oncopeptides, BMS, Celgene, and Takeda. CFdL: has served on advisory boards for Johnson & Johnson, BMS, Amgen, Pfizer, Sanofi, BeiGene, GSK, Roche, and Menarini; has received honoraria from Amgen, Johnson & Johnson, BMS, GSK, Sanofi, Pfizer, and BeiGene; has received research support from BMS, Johnson & Johnson, Amgen, and GSK; and is the principal investigator on trials evaluating the role of cesnicabtagene autoleucel (ARI0002 cells) in patients with multiple myeloma. RP: consulted and served on the advisory boards for Janssen, Sanofi, GSK, and Roche; has received research funding from GSK and Pfizer; has received honoria from Janssen, Pfizer, GSK, Abbvie, and BMS; and has received travel expenses from Janssen and GSK. PMu: reports honoraria for lectures with, and has served on the advisory boards for, Abbvie, Alexion, Amgen, Astellas, AstraZeneca, Bei-Gene, BMS, Gilead, GSK, Grifols, Incyte, Johnson & Johnson, Jazz, Novartis, Pfizer, Roche, Sanofi, Sobi, and Takeda. PR-O: consulted and served on the advisory boards for BMS, Johnson & Johnson, Sanofi, GSK, Pfizer, Oncopeptides, Menarini Stemline, H3 Biomedicines, and Roche; has received speaker's bureau fees from GSK, BMS, Johnson & Johnson, Pfizer, Sanofi, Abbvie, and Menarini Stemline; and has received travel support and research funding from Pfizer. KY: reports consultancy for Sanofi, Johnson & Johnson, and Pfizer; speaker fees from Sanofi, Takeda, and Pfizer; honoraria from Sanofi, Johnson & Johnson, Amgen, Takeda, Pfizer and BMS; and research funding Sanofi and BMS. LR: has received honoraria from Janssen, BMS, Sanofi, Pfizer, Amgen, GSK, and Roche, and research support from BMS. ET: has served on advisory boards for Amgen, AstraZeneca, EUSA Pharma, BMS, GSK, Johnson & Johnson, Menarini, Stemline, Pfizer, Sanofi, and Takeda; has received honoraria from Amgen, Antengene, AstraZeneca, EUSA Pharma, BMS, Forus, GSK, Johnson & Johnson, Menarini, Stemline, Novartis, Pfizer, Sanofi, Swixx, and Takeda; has received research funding from Amgen, GSK, Johnson & Johnson, Sanofi, and Takeda; and reports travel expenses from Takeda. MSR: consulted and served on the advisory boards for BMS, Celgene, Janssen, Amgen, Sanofi, GSK, and Novartis; has received research funding from BMS, Celgene, Janssen, and Sanofi; has received honoraria from BMS, Celgene, Janssen, Sanofi, and GSK; and has received travel support from Janssen, Amgen, and Sanofi. MB: reports honoraria from Sanofi, Celgene, Amgen, Janssen, Novartis, BMS, and AbbVie; has served on the advisory boards for Janssen and GSK; and reports research funding from Sanofi, Celgene, Amgen, Janssen, Novartis, BMS, and Mundipharma. PS: consulted and served on the advisory boards for BMS, Celgene, Janssen, Sanofi, GSK, and Pfizer; reports research funding from BMS, Celgene, Janssen, Karyopharm, Amgen, and Sanofi; and honoraria from BMS, Celgene, Janssen, Sanofi, and GSK. HE: consulted and served on the advisory boards for BMS, Celgene, Janssen, Amgen, Takeda, Sanofi, GSK, and Novartis; reports research funding for BMS, Celgene, Janssen, Amgen, GSK, and Sanofi; honoraria from BMS, Celgene, Janssen, Amgen, Takeda, Sanofi, GSK, and Novartis; and travel support from BMS, Celgene, Janssen, Amgen, Takeda, Novartis, and Sanofi. CLBMK reports no competing interests.

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