T-cell-redirecting therapies in early relapsed multiple myeloma: a systematic review and network meta-analysis

Chimeric antigen receptor T cells and bispecific antibodies, are moving from late-line salvage into early relapsed multiple myeloma. Indirect comparisons in heavily pretreated patients have favored cell therapy, but whether that hierarchy holds in early relapse is unknown.

We analyzed randomized phase 3 trials comparing a T-cell-redirecting therapy against a daratumumab-pomalidomide-dexamethasone-type control after at least one prior line. Pseudo-individual patient time-to-event data were reconstructed from published survival curves. Regimens were compared indirectly in Bayesian network meta-analyses reported under fixed-effect and random-effects assumptions, re-estimated in a frequentist graph-theoretical model. Control-arm dispersion was quantified by random-effects synthesis of median progression-free survival. Overall survival was additionally analyzed as restricted mean survival differences at 24 and 36 months. Safety and a cost-consequence analysis were assessed descriptively (PROSPERO: CRD420261431847).