ASCO 2026: Teclistamab boosts survival at first relapse in myeloma

Clinical Takeaway: For patients with relapsed/refractory multiple myeloma after 1 to 3 prior lines of therapy that included an anti-CD38 antibody and lenalidomide, teclistamab monotherapy significantly improved progression-free survival, overall survival, and depth of response versus standard-of-care PVd or Kd, although vigilant infection monitoring and prophylaxis remain essential.

As more multiple myeloma patients relapse after anti-CD38 antibodies and lenalidomide, effective chemotherapy-free options are urgently needed.

Teclistamab significantly improved outcomes in patients with relapsed/refractory multiple myeloma, according to results from the phase 3 MajesTEC-9 trial. At a median follow-up of 17.3 months, the BCMA×CD3 bispecific antibody reduced the risk of disease progression or death by 71% versus standard therapy (hazard ratio [HR], 0.29; P<0.001). Estimated progression-free survival at 18 months was 69.8% with teclistamab compared with 26.9% with pomalidomide-bortezomib-dexamethasone (PVd) or carfilzomib-dexamethasone (Kd). Overall survival also improved, with 18-month survival rates of 79.2% versus 68.6%, respectively (HR for death, 0.60; P=0.002).

Responses were substantially deeper with teclistamab. Overall response rates reached 84.5% compared with 54.2% for PVd/Kd, while complete response or better was achieved in 65.9% versus 16.8% of patients. Minimal residual disease–negative complete responses were also markedly more common with teclistamab.

The international trial enrolled 593 patients with multiple myeloma that had relapsed after 1 to 3 prior lines of therapy, all of whom had previously received an anti-CD38 monoclonal antibody and lenalidomide. Patients were randomized to receive teclistamab monotherapy or investigator’s choice of PVd or Kd. Most participants had disease refractory to both anti-CD38 therapy and an immunomodulatory drug, reflecting a population with limited treatment options.

“This is part of a much bigger transformation happening in myeloma care,” said senior author Ola Landgren, MD, PhD. “We are seeing very deep responses and long clinical benefit from these therapies.”

Safety findings were consistent with prior experience. Grade 3–4 infections occurred in 41.6% of teclistamab-treated patients versus 29.0% with standard therapy, while cytokine release syndrome was reported in 66.0% of teclistamab recipients and was predominantly grade 1–2.

These findings position teclistamab as a potent, off-the-shelf immunotherapy option that may shift bispecific antibodies into earlier lines of care for multiple myeloma.

Source: Touzeau C, et al; MajesTEC-9 Trial Investigators. (2026, May 29). N Engl J Med. Teclistamab in Multiple Myeloma with One to Three Previous Lines of Therapy