Transcript
Before I get started, I want to acknowledge that ASH 2025 showcased important advances across multiple targets for relapsed/refractory myeloma, including non-BCMA agents like cevostamab, and then potentially very important off-the-shelf CAR-T products that can help us with the logistics and cost of CAR-T manufacturing. No doubt these will become essential parts of our myeloma toolbox. But I think for right now, in day-to-day practice, BCMA still remains the most practical and widely accessible, effective target.
In this section, I want to talk about elranatamab. We had a couple of very important abstracts that came out that discussed combination therapy with elranatamab, which is one of our BCMA bispecific antibodies, and then a great abstract that included new real-world insights that really matter directly to how we use the drug in practice.
So, starting with elra in combination, we saw the MagnetisMM-30 study: elranatamab combined with iberdomide. This is a phase 1B study that evaluated elranatamab combined with iberdomide, which is a next-generation CELMoD, so currently not FDA approved, but a really important drug class. And the patients enrolled in this trial had BCMA-naive relapsed and refractory myeloma.
The results showed an overall response rate around 95%, with responses occurring quickly and deeply, even though iberdomide is early in development. Safety was manageable and aligned with what we would expect, so mostly low-grade CRS during step-up dosing, cytopenias, and there were no new reported toxicities. While I don’t think this combination is going to change practice immediately, it signals where the field is going: elra moving into combination backbones and into earlier lines of therapy, similar to our other BCMA bispecific products. So for us as APPs, this means preparing to manage overlapping cytopenias, infection risks, dose modifications, and then incorporating oral drug therapies while we do step-up dosing for bispecifics.
We also saw multiple real-world abstracts focused in the bispecific and CAR-T space, but in a real-world abstract on elranatamab, I think it’s especially valuable because it confirms how the drug behaves outside of clinical trials. I took a couple themes away from this. Number one, there are meaningful responses in frailer, older patients. So despite patients being older, having more comorbidities, more heavily pre-treated than in the MagnetisMM-3 trial, the abstract showed that response rates closely mirrored trialed outcomes. That’s really reassuring for us in everyday practice.
Also, CRS remained predictable and manageable. The CRS events with elra are common, but overwhelmingly, they’re grade 1 or 2, and they’re nearly always limited to the step-up period. ICANS was uncommon. This tells us our existing protocols are most likely very helpful and effective, and that elranatamab fits into the outpatient or hybrid step-up models that have also been well reported.
Cytopenias and infections do remain the major management challenge with elranatamab and our BCMA bispecifics. Almost every ASH real-world abstract emphasized this same point. Infection risk drives morbidity. Prolonged cytopenias, hypogammaglobulinemia, and viral and bacterial infections are highlighted repeatedly in any BCMA bispecific treatments. So for us as APPs, this reinforces the importance of standardized prophylaxis, the way we use IVIG, the way we plan for revaccination or vaccination in patients, and then our rapid evaluation pathways for fever or neutropenia, or those early CRS events.
So how do I think this relates to all of us in practice? Elranatamab remains a highly active BCMA bispecific that behaves predictably even off-trial. Its safe use relies on us as APPs having well-defined infrastructure, step-up dose readiness, infection prevention, and thoughtful patient selection for whether we’re going to begin inpatient or outpatient treatments. Combined with the MagnetisMM-30 data that include iberdomide, it’s clear that elra will continue moving into earlier lines and into combinations.
So the bottom line with the use of elranatamab from the ASH 2025 abstracts, we should have a lot of confidence in using it. The real-world usability was shown, and there’s future potential for its use in combination. Success with this drug depends less on the molecule itself, and more on the systems we build around it. We know it should work, so let’s strategize those symptoms and help patients have longer progression-free survival.
