New treatments for multiple myeloma are a popular topic of conversation among members of MyMyelomaTeam. Many discuss BCMA-targeted therapy, a promising new type of treatment for relapsing/refractory multiple myeloma (RRMM). “BCMA” stands for “B-cell maturation antigen.”

One member who had just begun taking an BCMA-targeted therapy wrote, “The drug isn’t chemo. It teaches your immune system to attack the BCMA receptor on the cancer cells and kill them.” Another responded, “Thanks for sharing this information. I’m going to speak to my oncologist about it.”

Learning all you can about new therapies is key to having good conversations with your doctor about treatment options. Perhaps you’ve already heard of anti-BCMA therapy, or maybe this type of treatment is new to you. Either way, keep reading to learn more details about BCMA-targeted drugs.

What Is BCMA?

In multiple myeloma, plasma cells develop genetic changes that cause them to become cancerous. B-cell maturation antigen is a protein found on nearly all multiple myeloma cells — and isn’t usually found on any healthy cells aside from plasma cells. Since BCMA is on myeloma cells but not regular cells, it’s an effective target treating multiple myeloma.

Anti-BCMA treatments are a type of immunotherapy. This treatment approach uses a person’s own immune system to fight disease. Anti-BCMA is a targeted treatment that focuses mainly on destroying cancer cells, leaving most healthy cells intact. This makes anti-BCMA therapy a very different approach from other myeloma treatments like chemotherapy, radiation, bone marrow transplants, and surgery.

Who Are BCMA-Targeted Therapies for?

BCMA-targeted therapies are approved for adults living with relapsed/refractory multiple myeloma. Relapsed myeloma happens when myeloma treatments work at first, but then the blood cancer returns. Refractory multiple myeloma happens when the blood cancer does not respond to treatment at all.

Doctors will recommend anti-BCMA therapies only if you’ve had at least four treatment regimens, with at least three types of drugs. These might include:

• An immunomodulatory drug, such as pomalidomide (Pomalyst), lenalidomide (Revlimid), or thalidomide (Thalomid)
• A proteasome inhibitor, such as ixazomib (Nilaro), carfilzomib (Kyprolis), or bortezomib (Velcade)
• An anti-CD38 drug, such as daratumumab (Darzalex) or isatuximab-ifrc (Sarclisa)

Currently Approved BCMA Therapies

BCMA-targeted therapies are a new modality, or type of treatment, for myeloma. As of August 2023, there are four anti-BCMA therapies approved by the U.S. Food and Drug Administration (FDA) for the treatment of multiple myeloma. These are:

• Idecabtagene vicleucel (Abecma)
• Ciltacabtagene autoleucel (Carvykti)
• Teclistamab-cqyv (Tecvayli)
• Elranatamab-bcmm (Elrexfio)

Although these are all anti-BCMA therapies, they each target BCMA in a slightly different way. Teclistamab-cqyv and elranatamab-bcmm are bispecific T-cell engagers (BiTEs). Idecabtagene vicleucel and ciltacabtagene autoleucel are chimeric antigen receptor T-cell (CAR T-cell) therapies.

Idecabtagene Vicleucel

Idecabtagene vicleucel, sold under the brand name Abecma, is a CAR T-cell therapy. CAR T-cell therapy works by modifying your T cells. To treat multiple myeloma, your own T cells are altered so they identify, target, and attack BCMA on myeloma cells. CAR T-cell therapies are developed specifically for a single person and given in one infusion.

The FDA approved Abcema for relapsing/refractory multiple myeloma in March 2021 based on results in clinical trials. In these trials, the overall response rate (the number of people whose blood cancer went away or got partially better) for Abecma was 72 percent. The complete response rate (the number of people whose blood cancer was undetectable on tests after treatment) was 28 percent. Among those who had a complete response, 65 percent had their response last for at least a year before myeloma appeared again. (This measure is known as the duration of response.)

Ciltacabtagene Autoleucel

Ciltacabtagene autoleucel, sold under the brand name Carvykti, is another type of CAR T-cell therapy. The FDA approved Carvykti in February 2022 for treating relapsing/refractory multiple myeloma .

Like Abecma, Carvykti is a CAR-T cell therapy given as a single infusion, but they have differences. Abecma binds to BCMA in one place. Carvykti, on the other hand, binds to BCMA in two places.

Carvykti was approved based on the overall response rate and the duration of response in clinical trials. Carvykti’s overall response rate was 98 percent. Its median duration of response was 22 months. This means that, for half of the people in the trials, the treatment results lasted longer than 22 months, while half of the people saw their myeloma begin to return in less than 22 months.

Although anti-BCMA CAR T-cell therapies are approved for people living with RRMM, they can be difficult to get. They require time to be developed for each person, so they may not be the best option for people who need treatment immediately.

Teclistamab-cqyv

Bispecific T-cell engagers are another new treatment for relapsing/refractory multiple myeloma. BiTEs use monoclonal antibodies, laboratory-made proteins that work like natural human antibodies. Antibodies help your body recognize and remove unhealthy bacteria, viruses, and cancerous cells.

BiTEs like teclistamab-cqvy fight myeloma by binding in two ways. First, the bispecific antibody binds to BCMA on the myeloma cell. The anti-BCMA antibody also binds to a nearby T cell. After the antibody binds to both of these cells, the T cell’s cytotoxic (cell-killing) ability is activated. The T cell releases material that kills the myeloma cell.

In October 2022, teclistamab-cqvy (sold under the brand name Tecvayli) became the first FDA-approved BCMA bispecific antibody for the treatment of multiple myeloma. Tecvayli was approved based on the overall response rate in clinical trials. The overall response rate for this bispecific antibody was 62 percent. It’s given subcutaneously (under the skin).

Elranatamab-bcmm

Elranatamab-bcmm, sold under the brand name Elrexfio, is a BCMA bispecific antibody approved by the FDA in August 2023. In clinical trials, the overall response rate of Elrexfio for the treatment of multiple myeloma was 58 percent.

Elrexfio is given under the skin. It also works by binding to BCMA on myeloma tumor cells and T cells, causing myeloma cell death.

Treatment with BCMA bispecific antibodies is easier to access than the CAR T-cell therapies because they don’t have to be manufactured specifically for each person. Bispecific antibody treatments are “off the shelf” and available right away.

Side Effects of BCMA-Targeted Therapies

Like all medications — even those sold over the counter — anti-BCMA therapies have potential side effects or toxicities. Not every person will experience every side effect. Your doctor knows the details of your personal health condition and can advise you about your risk for different side effects.

Common Side Effects

All four BCMA-targeted therapies for RRMM share some common side effects. The common side effects are:

• Cytokine release syndrome (when the immune system releases too many proteins, affecting other cells)
• Infection
• Tiredness
• Musculoskeletal pain (pain in the muscles, bone, joints, ligaments, or tendons)
• Diarrhea
• Nausea
• Fever
• Cough
• Headache
• Poor appetite

Rare Side Effects Specific to Abecma

The FDA prescribing information lists rare but serious side effects of Abecma for the treatment of multiple myeloma, including:

• Bleeding disorders
• Abnormal heartbeat
• Cardiomyopathy (issues with heart muscle pumping)
• Gastrointestinal bleeding
• Hemophagocytic lymphohistiocytosis (buildup of blood cells that causes damage)
• Severe infection
• Seizure
• Blood clots
• Abnormal buildup of lung fluid

Rare Side Effects Specific to Carvykti

Rare but serious side effects of Carvykti for the treatment of multiple myeloma include:

• Abnormal heartbeat
• Chest pain
• Buildup of blood cells, causing damage
• Tumor lysis syndrome (when tumor contents seep into the bloodstream)
• Stroke
• Seizure
• Kidney failure
• Blood clots

Rare Side Effects Specific to Tecvayli

Rare but serious side effects specific to Tecvayli for the treatment of multiple myeloma include:

• Febrile neutropenia (high fever with low blood cell counts)
• Immune effector cell-associated neurotoxicity or ICANS (severe side effects related to brain function, such as confusion and problems talking)
• Severe infection
• Seizure
• Guillain-Barré syndrome (an autoimmune nerve condition)
• Liver failure

Rare Side Effects Specific to Elrexfio

Rare but serious side effects of Elrexfio for the treatment of multiple myeloma include:

• ICANS
• High fever with low blood counts
• Guillain-Barré syndrome
• Heart failure
• Blood clots

Learn More About Anti-BCMA Immunotherapy

If you or your loved one with myeloma already tried four treatments for multiple myeloma that haven’t worked, or your myeloma has relapsed after four or more lines of therapy, you may qualify for BCMA-targeted immunotherapy. If you’d like to learn more about anti-BCMA treatments, ask your myeloma specialist if they might be safe and effective for you.

Talk With Others Who Understand

MyMyelomaTeam is a social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 20,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma.

Have you considered or tried an anti-BMCA immunotherapy? Share your experiences in the comments below, or start a conversation by posting on your Activities page.