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MM-1173: Comparative Outcomes of CAR-T vs Bispecific T Cell–Engager Therapy in Relapsed/Refractory Multiple Myeloma: A TriNetX Network Analysis
Abstract   Peer reviewed

MM-1173: Comparative Outcomes of CAR-T vs Bispecific T Cell–Engager Therapy in Relapsed/Refractory Multiple Myeloma: A TriNetX Network Analysis

Faiza Khan, Ali Mohsin, Aleenah Mohsin, Hasan Ilyas, Muhammad Furqan, Muhammad Usman Haider, Hadier Bin Khalid, Ishtiaq Ahmad, Muhammad Tayyab Tahir and Ghulam Mustafa
Clinical lymphoma, myeloma and leukemia, Vol.26(Supplement 1), pp.S1152-S1153
08/2026
DOI: 10.1016/S2152-2650(26)02997-6

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Abstract

Background: CAR-T therapy and bispecific T-cell engagers (BiTEs) have transformed treatment for RRMM, but comparative real-world data remain limited. Methods: We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Adult RRMM patients treated between March 2021 and May 2025 with CAR-T (idecabtagene vicleucel or ciltacabtagene autoleucel) or BiTE (talquetamab, teclistamab, elranatamab, or linvoseltamab) therapy were identified. Propensity score matching balanced baseline demographic and clinical characteristics, including current age, age at index event, sex, race/ethnicity, neoplasm diagnosis status, prior chemotherapy exposure, and antineoplastic therapy use. Primary outcomes were all-cause mortality at 1, 3, and 5 years. Secondary outcomes included CRS, ICANS, cytopenias, and bacterial infections. Results: Mortality analyses included 862 matched patients per cohort. CAR-T, compared with BiTE, was associated with significantly lower mortality across all time points. At 1 year, mortality occurred in 93 CAR-T vs 216 BiTE patients, with survival probabilities of 86.4% vs 69.8% (HR, 0.39; 95% CI, 0.31–0.50; P < 0.001). At 3 years, mortality occurred in 121 vs 265 patients, with survival probabilities of 73.0% vs 53.6% (HR, 0.41; 95% CI, 0.33–0.51; P < 0.001). At 5 years, mortality occurred in 125 vs 253 patients, with survival probabilities of 66.3% vs 52.0% (HR, 0.44; 95% CI, 0.35–0.54; P < 0.001). Secondary outcomes included 932 matched patients per cohort, evaluated at 1, 3, and 6 months. At 1 month, CAR-T showed higher CRS (16.8% vs 8.8%; HR, 1.98; 95% CI, 1.52–2.59), ICANS (9.9% vs 3.8%; HR, 2.69; 95% CI, 1.82–3.97), thrombocytopenia (24.2% vs 17.1%; HR, 1.41; 95% CI, 1.15–1.73), and neutropenia (31.8% vs 7.6%; HR, 4.17; 95% CI, 3.27–5.31). At 3 months, thrombocytopenia (32.7% vs 22.5%; HR, 1.48; 95% CI, 1.24–1.76) and neutropenia (37.1% vs 13.8%; HR, 3.21; 95% CI, 2.62–3.93) remained higher with CAR-T. At 6 months, CAR-T continued to demonstrate elevated CRS, ICANS, thrombocytopenia, and neutropenia without significant differences in bacterial infections. Conclusion: CAR-T therapy, compared with BiTE therapy, demonstrated superior survival in RRMM but was associated with greater immune-mediated and hematologic toxicities, thus highlighting the tradeoff between efficacy and treatment-related risk. CAR-T: chimeric antigen receptor T-cell, CI: confidence interval, CRS: cytokine release syndrome, HR: hazard ratio, ICANS: immune effector cell–associated neurotoxicity syndrome, RRMM: relapsed/refractory multiple myeloma.
 bispecific T-cell engager BiTE CAR-T therapy

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