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Immunotherapy is a type of cancer treatment that uses or redirects your immune system to fight cancer. In recent years, immunotherapy has become an important type of treatment for people with relapsed or refractory multiple myeloma (RRMM).
“Relapsed” means the cancer has returned after treatment. “Refractory” means it didn’t respond to treatment or stopped responding.
Some immunotherapies help immune cells recognize myeloma cells and kill them. Others bring cancer-fighting immune cells directly to myeloma cells. Several treatments once reserved for people with RRMM who had tried many other lines of therapy can now be used earlier.
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This article discusses how different types of immunotherapy for RRMM work, including monoclonal antibodies, bispecific antibodies, chimeric antigen receptor (CAR) T-cell therapy, and antibody-drug conjugates (ADCs).
Monoclonal antibodies are lab-made versions of immune system proteins that attach to specific targets on cancer cells. Binding to these targets helps the immune system recognize and destroy myeloma cells. Monoclonal antibodies are usually combined with other treatments and given by IV infusion or injection into the fat under the skin.
Daratumumab Daratumumab (Darzalex) targets CD38, a protein found in large amounts on many myeloma cells. Attaching to CD38 helps the immune system recognize and destroy these cancer cells.
Daratumumab was the first drug of this type to be approved. It’s used in many combinations at different points in the treatment journey.
Most recently, in 2026, the U.S. Food and Drug Administration (FDA) granted accelerated approval to a new combination of daratumumab with hyaluronidase-fihj (Darzalex Faspro), iberdomide (Zenbexus), and dexamethasone for adults with RRMM who had received at least one previous line of treatment. Iberdomide is an oral drug called a CELMoD, short for cereblon E3 ligase modulator.
Isatuximab-Irfc Isatuximab-irfc (Sarclisa) also targets CD38. It helps the immune system recognize and attack myeloma cells and can kill some myeloma cells directly.
The FDA first approved isatuximab-irfc in 2020 for previously treated multiple myeloma. It’s given by IV or subcutaneous (under the skin) injection and is used with other myeloma medications. Whether it’s recommended for RRMM depends in part on which treatments a person has already received.
Elotuzumab Elotuzumab (Empliciti) targets a protein called SLAMF7. SLAMF7 is found on myeloma cells and on natural killer cells, a type of immune cell that can destroy abnormal cells.
The FDA first approved elotuzumab in 2015. It’s given intravenously and used with other multiple myeloma medications rather than by itself. For RRMM, it can be an option after previous treatment, depending on the drug combination.
CAR T-cell therapy changes a person’s own T cells so they’re better able to recognize and attack myeloma. T cells are collected from the blood and changed in a laboratory to carry a chimeric antigen receptor. The cells are then multiplied and returned through an IV infusion.
CAR T-cell therapy is generally given as a one-time infusion. However, collecting and preparing the cells takes time, and chemotherapy is given beforehand to prepare the body for the CAR T cells.
Both FDA-approved CAR T-cell therapies for multiple myeloma target B-cell maturation antigen (BCMA), a protein found on many myeloma cells.
Idecabtagene-Vicleucel Idecabtagene-vicleucel (Abecma) was first approved for multiple myeloma in 2021. In 2024, its approval expanded to certain adults with RRMM after two or more previous lines of therapy, including an immunomodulatory drug, a proteasome inhibitor, and an anti-CD38 antibody.
Ciltacabtagene-Autoleucel Ciltacabtagene-autoleucel (Carvykti) was first approved in 2022. In 2024, the FDA expanded its use to certain adults with RRMM after at least one previous line if they had received a proteasome inhibitor and an immunomodulatory drug and their myeloma was resistant to lenalidomide (Revlimid). This made CAR T-cell therapy available earlier for some people.
Bispecific antibodies are molecules that attach to two targets at the same time. One end binds to a protein on a myeloma cell, while the other binds to CD3 on T cells. Bispecific antibodies act like a bridge, bringing T cells close enough to attack the cancer.
Although CAR T-cell therapies need to be manufactured individually for each person, bispecific antibodies are ready-made medications. Most are given as injections under the skin, usually starting with smaller “step-up” doses.
Teclistamab-Cqyv Teclistamab-cqyv (Tecvayli) became the first FDA-approved bispecific antibody for multiple myeloma in 2022. It connects CD3 on T cells with BCMA on myeloma cells.
Teclistamab-cqyv was first approved for people with RRMM after at least four previous lines of treatment. In March 2026, the FDA approved teclistamab-cqyv with daratumumab and hyaluronidase-fihj (Darzalex Faspro) for adults with RRMM after at least one previous line of treatment that included a proteasome inhibitor and an immunomodulatory drug.
This approval made bispecific-antibody treatment available much earlier for some people with RRMM.
Elranatamab-Bcmm Elranatamab-bcmm (Elrexfio) received accelerated FDA approval in 2023. Like teclistamab-cqyv, it connects CD3 on T cells with BCMA on myeloma cells.
This medication is approved for adults with RRMM after at least four previous lines, including a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 antibody. It’s given as an injection under the skin.
Talquetamab-Tgvs Talquetamab-tgvs (Talvey) received accelerated FDA approval in 2023 for adults with RRMM after at least four previous lines of treatment.
Instead of BCMA, talquetamab-tgvs targets a myeloma cell protein called GPRC5D (short for G-protein-coupled receptor family C, group 5, member D) while also attaching to CD3 on T cells. Because it uses a different target, talquetamab-tgvs may provide another option for some people who have already received BCMA-directed treatment. It’s injected under the skin.
Linvoseltamab-Gcpt Linvoseltamab-gcpt (Lynozyfic) received accelerated FDA approval in July 2025. It targets BCMA on myeloma cells and CD3 on T cells.
This medication is approved for adults with RRMM after at least four previous lines of therapy, including a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 antibody. Linvoseltamab-gcpt is given by IV infusion, with step-up doses used at the start of treatment.
An ADC combines an antibody with a cancer-killing drug. The antibody binds to cells carrying a specific target and delivers the drug directly to them. This differs from CAR T-cell therapy and bispecific antibodies, which use T cells to attack myeloma.
Belantamab Mafodotin-Blmf Belantamab mafodotin-blmf (Blenrep) targets BCMA on myeloma cells and delivers a cancer-killing drug inside them. This ADC first received accelerated FDA approval in 2020 for heavily pretreated RRMM. It was withdrawn from the U.S. market in 2023 after a required follow-up study didn’t confirm its benefit.
Later studies tested belantamab mafodotin-blmf in new combinations. In October 2025, the FDA approved it again with bortezomib and dexamethasone for adults with RRMM after at least two previous lines, including a proteasome inhibitor and an immunomodulatory drug. This provides another BCMA-targeted treatment option for some people with RRMM.
What About Checkpoint Inhibitors? Checkpoint inhibitors such as pembrolizumab and nivolumab remove some of the immune system’s natural “brakes,” allowing immune cells to attack cancer more strongly.
Although checkpoint inhibitors work well for some cancers, they haven’t shown the same success in multiple myeloma. Some combinations studied in multiple myeloma also raised serious safety concerns. For this reason, checkpoint inhibitors aren’t standard FDA-approved treatments for multiple myeloma.
New immunotherapies are becoming available, and some can now be used earlier in RRMM treatment.
The right treatment for you depends on which treatments you’ve already received, how your myeloma responded, your overall health, and whether you’ve had a BCMA-directed treatment before. You should also share your treatment goals and preferences with your myeloma specialist.
Your cancer care team can help you compare the possible benefits and risks, including potential side effects, and discuss whether a newer treatment or joining a clinical trial may be an option.
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Darzalex and IVIg have helped me tremendously. I also take Pomalyst 21 days on and 7 days off. As with any treatment, there are side effects, most of which have been manageable. I wish everyone the… read more
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