Bispecific and Cellular Therapies to Transform Multiple Myeloma Treatment
At the 2026 LL&M Winter Symposium in Amelia Island, Florida, Ajay Nooka, MD, Winship Cancer Institute, Atlanta, Georgia, discusses practice-changing advances in multiple myeloma emerging from 2025 data.
Dr Nooka highlights early use of bispecific antibody combinations, expanding roles for CAR T-cell therapy in earlier lines, and the development of next-generation cereblon E3 ligase modulators. These advances are reshaping treatment strategies and may move highly effective therapies into earlier disease settings.
Transcript:
My name is Ajay Nooka, I’m the director of the myeloma program at the Emory University Winship Cancer Institute, I’m a professor of hematology and oncology. I’m here at the LL&M Winter Symposium discussing the 2025 discoveries that are practice-changing in 2026.
There’s a lot of enthusiasm from 2025 that gets carried into 2026 to be practice-changing. There are a lot of updates in the bispecific area, a lot of updates in the cellular therapy area, and the non–T cell–redirecting area as well.
Let me talk about the bispecifics. We do have combination data with these bispecifics very early in the course, and this is in early relapsed multiple myeloma. The best example is MajesTEC-3, it is a study randomizing patients who receive standard-of-care therapy with daratumumab, pomalidomide, and dexamethasone or daratumumab, bortezomib, and dexamethasone versus the investigational arm of teclistamab and daratumumab, showing the benefit for this investigational combination with a hazard ratio of 0.17. These are unprecedented results never seen in multiple myeloma history.
In the same theme, we are seeing a lot of combination data, whether it is data combining alnuctamab with iberdomide or teclistamab combined with talquetamab, all of these have shown that the safety signal is not increased—the toxicity signal is not seen. At the same time, the efficacy doubles, or at least there is an additive effect. This is allowing us to use these combinations very early in the course, and in the future, we might even see them in the newly diagnosed setting as well.
If you think about it from the perspective of CAR T-cells, we are seeing not only newer constructs, including in vivo approaches, but we are also seeing the use of earlier constructs targeting BCMA—ciltacabtagene autoleucel and idecabtagene vicleucel—being used more in earlier lines of therapy and there are data showing safety in standard-risk patients as well.
Moving to the CELMoDs, the cereblon E3 ligase–modulating agents, previously called immunomodulators, we now have these new drugs. The 2 drugs that are under consideration and have been under evaluation for a long time are iberdomide and mezigdomide. Think about this as a newer lenalidomide and a newer pomalidomide that we’ll be seeing in the future, so stay tuned.
There are a lot of changes that are coming, the landscape continues to change in multiple myeloma more than in any other field. Please talk to your colleagues, especially your academic colleagues, so that you stay up to date and are able to provide the same kind of care that patients receive in an academic center in the community setting.
Source:
Nooka A. From 2025 discoveries to 2026 practice: Evolving strategies in early relapsed myeloma. Presented at Lymphoma, Leukemia & Myeloma Winter Symposium; January 30 - February 1, 2026. Amelia Island, Florida.
