What Treatments Can be Used Following a BCMA Relapse in Myeloma?

Some of the most dramatic advances in multiple myeloma treatment include BCMA-targeting treatments - CAR T and bispecific antibodies. But if patients relapse after one of those, is there still hope?

Gurbakhash Kaur, MD from UT Southwestern at the American Society of Hematology 2022 conference shows that patients who have received BCMA-specific therapy can respond to other BCMA-bispecific antibodies and CAR T therapy, even after relapse. They can also continue to respond to CAR T or bispecific antibodies going after different targets. 

About BCMA

BCMA, or B-cell maturation antigen, is a protein found on the surface of plasma cells that helps to regulate the growth and survival of B-cells, but is also found on myeloma cells in abnormally large amounts.

BCMA Bispecific Antibodies

BCMA targeting bi-specific antibodies can help the patient’s own immune system to target BCMA proteins in order to destroy myeloma cells. (For a better explanation on how bispecific antibodies work to kill myeloma, check out this video on HealthTree University.)

Dr. Kaur mentions that even using a different BCMA bispecific antibody after an initial BCMA bispecific antibody may be effective, citing the results of the elranatamab study that included prior BCMA exposed patients. 

Another option is to use a bispecific antibody going after a different target, like GPRC5D. Talquetemab showed positive results in its clinical trials for prior BCMA-exposed patients. GPRC5D is another protein found on myeloma cells that bispecific antibodies can target.

CAR T Therapy

One of the most promising BCMA-specific therapies is CAR-T cell therapy.

This involves taking a patient's own T cells, a type of immune cell, and genetically modifying them so that they will bind to BCMA. These modified T cells are then infused back into the patient where they are activated to target and destroy the cancer cells. To learn more about how CAR-T cell therapy works, check out this HealthTree University video.  

Other BCMA Options

At the ASH 2022 conference, many researchers presented data addressing the concern of relapse after BCMA-specific therapy. Data showed that patients who have received BCMA-specific therapy can go on to respond to other BCMA bispecific antibodies, such as belantamab-mafodotin (currently off the market but potentially coming back on next year).

Further research and development in bispecific antibody and CAR T therapy can lead to new and more effective treatment options for myeloma patients, instilling more hope to the myeloma community. 

You can read more about the specific research and potential therapies related to progression after BCMA-targeted CAR-T therapy here.