2025 年 65 巻 4 号 p. 225-237
The advent of T-cell-redirecting therapies has considerably reshaped the treatment landscape for relapsed/refractory multiple myeloma (RRMM), particularly in patients with triple-class exposed or refractory disease. Chimeric antigen receptor (CAR) T-cell therapies and bispecific antibodies (BsAbs), which primarily target B-cell maturation antigen (BCMA), have shown remarkable efficacy in pivotal trials and real-world settings. More recently, G protein-coupled receptor class C group 5 member D-targeted agents have emerged as promising options, particularly for patients who relapse after undergoing BCMA-directed therapy. CAR T-cell therapies can induce deep and durable responses with the potential for long-term remission. However, their use is limited because of manufacturing delays, center certification requirements, and severe toxicity risks. BsAbs offer the advantage of being off-the-shelf, enabling immediate treatment initiation and generally manageable safety profiles, making them the preferred option for frail patients or those with rapidly progressing disease. Nevertheless, continuous dosing and cumulative immunosuppression remain a clinical challenge. Although no direct comparative trials exist between CAR T-cell therapies and BsAbs, each modality has distinct advantages and limitations. Treatment decisions should be individualized based on disease characteristics, patient conditions, and institutional capabilities. Future directions include integrating these agents into earlier lines of therapy, developing novel targets, and exploring multi-antigen strategies to overcome antigen escape. As this field rapidly evolves, real-world evidence and personalized treatment approaches will become critical for optimizing outcomes in patients with RRMM. This review provides an up-to-date summary of the current T-cell-redirecting therapies, including their clinical profiles and safety considerations.
