Could Teclistamab Help Newly Diagnosed Myeloma Patients Live Longer After Transplant?

Early findings of two important clinical trials were presented at the 66th annual American Society of Hematology meeting. The main focus was on teclistamab, specifically for newly diagnosed multiple myeloma. Both trials aimed to explore whether adding it to standard care could improve outcomes in autologous stem cell transplant (ASCT), a common first treatment step for eligible patients.

What Is Teclistamab and Why Are Researchers Testing It So Early?

Teclistamab (Tecvayli) is a bispecific antibody that targets two proteins: BCMA on myeloma cells and CD3 on T-cells, helping the immune system target cancer. It has already been approved for people whose myeloma has returned after trying several other therapies.

Two recent studies: MajesTEC-4 and MajesTEC-5, explored teclistamab as part of maintenance and induction therapies in newly diagnosed patients. They intended to answer the question of: could teclistamab help patients earlier in their treatment journey, particularly those eligible for a stem cell transplant? 

Post-Transplant: Can Teclistamab Keep Myeloma Away Longer?

The MajesTEC-4 trial studied teclistamab in three situations: 

• In combination with lenalidomide (Revlimid) 
• Alone, compared with lenalidomide by itself
• As maintenance therapy after ASCT

Early results suggest that teclistamab, especially with lenalidomide, could help deepen responses and delay relapse after transplant. It may also be manageable with adjusted dosing schedules.

In the early “safety run-in” phase of the study:

• At a median follow-up of about 5 to 14 months, nearly all patients (97%) remained on treatment, suggesting early tolerability.
• Serious side effects like low white blood cell counts and infections were less common with less frequent dosing, a sign that adjusting how often patients receive teclistamab might reduce risk.
• In the group receiving both lenalidomide and teclistamab, 100% of patients evaluated after one year had no measurable disease (MRD-negative complete response).
• None of the patients had cancer progression at the time of reporting.

Can Teclistamab Strengthen First Responses to Treatment?

The MajesTEC-5 trial looked at teclistamab as part of induction therapy (the first treatment before stem cell collection and transplant). Researchers combined teclistamab with daratumumab (Darzalex), lenalidomide, dexamethasone (Tec-DRd), and in one group also added bortezomib (Velcade) (Tec-DVRd).

Among the 49 patients enrolled:

• After three treatment cycles, 35 patients achieved MRD-negativity.
• Those who continued to six cycles all maintained MRD-negative status.
• Stem cell collection was successful, showing that adding teclistamab didn’t block the ability to move forward with transplant.
• No patients stopped treatment due to side effects. The most common side effects were low immune cell counts and cytokine release syndrome.

This early data suggests teclistamab may boost early response to therapy without interfering with stem cell collection or causing major new risks.

Teclistamab Takeaways for Newly Diagnosed Myeloma Patients

Both studies show that teclistamab could have a role at different stages of early multiple myeloma treatment, either before or after transplant. 

• Deeper responses: Many patients achieved MRD-negativity, which is associated with longer remissions.
• Manageable side effects: With careful dosing, side effects were tolerable and didn't lead to major treatment interruptions.
• New potential addition: Teclistamab did not appear to interfere with stem cell collection or transplant, making it a viable option around standard therapies.

These findings are early but hold great results for further research. The longer-term results will help confirm how well teclistamab works for newly diagnosed myeloma patients receiving ASCT. Patients should continue to discuss their options with their healthcare teams as new maintenance and induction strategies are emerging.

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Sources:

• Phase 2 Study of Teclistamab-Based Induction Regimens in Patients with Transplant-Eligible (TE) Newly Diagnosed Multiple Myeloma (NDMM): Results from the GMMG-HD10/DSMM-XX (MajesTEC-5) Trial
• Phase 3 Study of Teclistamab (Tec) in Combination with Lenalidomide (Len) and Tec Alone Versus Len Alone in Newly Diagnosed Multiple Myeloma (NDMM) As Maintenance Therapy Following Autologous Stem Cell Transplantation (ASCT): Safety Run-in (SRI) Results from the Majestec-4/EMN30 Trial