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Comparative Efficacy and Safety of BCMA-Targeted CAR T
Cells and BiTEs in Relapsed/Refractory Multiple Myeloma:
A Meta-analysis of Interventional and Real-World Studies
Pisanupong Techaapornkun1, Waranyoo Rojpalakorn1, Nuthchaya Mejun1, Asmita Khaniya2
,
Arsa Thammahong3, May Soe Thu2, Nattiya Hirankarn2
, Palada Pitakkitnukun4,5*
1 Faculty of Medicine, Chulalongkorn University
2 Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Medical
Microbiology, Faculty of Medicine, Chulalongkorn University
3 Center of Excellence in Antimicrobial Resistance and Stewardship, Department of Microbiology,
Faculty of Medicine, Chulalongkorn University
4 Excellence Center for Comprehensive Cancer (ECCCC), King Chulalongkorn Memorial Hospital
5 Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University
*Corresponding Author E-mail: palada.p@chula.ac.th
Abstract
Background: Objective: Despite therapeutic advancements, multiple myeloma (MM) remains incurable, particularly in
relapsed/refractory (R/R) cases. B-cell maturation antigen (BCMA) is a promising target for
immunotherapies, including chimeric antigen receptor T-cell (CAR-T) therapies and bispecific
T-cell engagers (BiTEs), which differ in efficacy, toxicity, and accessibility.
To compare the efficacy and safety of BCMA-directed CAR-T therapies and BiTEs in patients with
R/R MM through a systematic review and meta-analysis.
Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted up to
October 2nd, 2024. Thirty studies involving 2,493 patients were included. Subgroup and meta-
regression analyses were conducted to explore the impact of CAR-T construct types, and patient
characteristics.
Results: Conclusion: CAR-T therapies demonstrated higher overall response rate (ORR) of 84% and a complete/strin-
gent complete response (CR/sCR) rate of 55%, compared to 65% and 41%, respectively, for BiTEs.
Dual-targeted CAR-T therapies (e.g. anti-BCMA + anti-CD38 or CD19) showed the highest effica-
cy (ORR 92%). However, CAR-Ts were associated with greater hematologic toxicity and cytokine
release syndrome. BiTEs had fewer severe adverse events but higher infection rates. Meta-
regression confirmed that CAR-T significantly outperformed BiTEs. Data from the real-world studies
showed a lower rate of ORR, shorter progression-free survival (PFS), and overall survival (OS)
in patients who previously received BCMA-targeted therapy compared to those who were BCMA-
treatment naive. Unlike previous analyses, our study incorporates interventional and real-world
data, evaluates dual-target CAR-T therapies, and provides detailed comparisons of CAR-T
products, safety profiles, and patient subgroups—offering a broader and more clinically relevant
assessment.
BCMA-targeted CAR-T therapies offer deeper ORR in R/R MM but with higher toxicity. BiTEs
provide lesser ORR but a safer alternative for patients unfit for CAR-T. This study supports more
patient-tailored decision-making for BCMA-directed immunotherapy in multiple myeloma.
Harmony in health: Innovation for Sustainable Medicine
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