When you have refractory multiple myeloma, the cancer stops responding or doesn't improve with treatment. There's no cure for multiple myeloma, so a different treatment is the key for keeping the disease under control. Now, there are more options for refractory multiple myeloma than ever before. "There is a lot of excitement about new and upcoming therapies for multiple myeloma," says Lore Gruenbaum, PhD, the chief scientific officer at Blood Cancer United.
Scientists are uncovering ways to stop and slow the blood cancer growth, like immunotherapy. These drugs stimulate the body's own immune system to attack tumor cells, Gruenbaum says.
Targeted therapies that pinpoint specific parts of the cancer cells, such as proteins or genes, are emerging. Researchers are developing new targets, which open the door for more treatments, says Ciara Freeman, MD, PhD, the clinical research medical director of blood and marrow transplant and cellular immunotherapy at Moffitt Cancer Center.
Over the past few years, the FDA has approved new drugs, such as belantamab mafodotin-blmf (Blenrep), for refractory multiple myeloma. It also expanded the use of others, such as ciltacabtagene autoleucel (Carvykti) and idecabtagene vicleuce (Abecma), for earlier treatment, and fast-tracked daratumumab for approval. There are clinical trials studying promising medicines, with many others in development.
With the recent scientific breakthroughs, it's a time of hope for people with refractory multiple myeloma, Gruenbaum says. "We're looking to treat multiple myeloma like a chronic disease with good options to continue life and ease symptoms, and we're moving even closer to a cure."
Here are some of the most exciting new and upcoming treatments for refractory multiple myeloma.
CAR T-Cell Therapies
This immunotherapy programs your own white blood cells, called T cells, to attack cancer cells. During the process, your white blood cells are filtered out of a blood draw. At a lab, scientists insert a new gene to turn them into CAR T cells. They have receptors that target proteins, such as BCMA, on cancer cells. After they're infused back into your body, these cells seek out cancer cells to destroy them.
Some of the most recent CAR T-cell therapies for refractory multiple myeloma include:
- Idecabtagene vicleuce (Abecma). Not long ago, CAR T-cell therapies were only used for refractory multiple myeloma after patients tried at least four other treatments that didn't work. But in 2024, the FDA approved this medicine for patients after two prior treatments. This expands the options for refractory multiple myeloma, Freeman says, who notes that earlier CAR T-cell therapy treatments can improve both function and outcomes in patients.
- Ciltacabtagene autoleucel (Carvykti). Doctors can prescribe this medicine after one previous treatment. A recent study found that one-third of patients with refractory multiple myeloma who received a ciltacabtagene autoleucel infusion didn't have a progression in their cancer after five or more years. "CAR T-cell therapies are very promising for long-term remission," Gruenbaum says.
- Anitocabtagene autoleucel, which is called anito-cel, is a CAR T-cell therapy in clinical research trials. Research suggests that the medicine works well and has fewer side effects like nervous system damage than other CAR T-cell therapies. "The data is very promising for FDA approval," Gruenbaum says.
Bispecific Antibodies
These immunotherapy medicines use an antibody that targets two proteins: BCMA on cancer cells and CD3 on T cells. This connects the cancer with immune cells, which kills them. "Scientists are studying bispecific medicines in combination with different cancer therapies and finding better responses," Gruenbaum says. "That's an exciting area of research, and these therapies could become a new standard of care."
While CAR T-cell therapies are usually done in specialized academic cancer centers, bispecific antibody treatments allow patients to receive care closer to home.
The newest bispecific antibodies and their combinations include:
- Teclistamab (Tecvayli) with daratumumab. Approved in 2022, teclistamab was the first bispecific antibody approved for refractory multiple myeloma. More recent research shows that taking teclistamab with another targeted therapy, daratumumab, makes it even more potent. Daratumumab is an antibody that binds to the CD38 antibody on cancer cells, which tells the immune system to destroy them. In a 2025 study, scientists found that 84% of patients who took teclistamab along with targeted therapy daratumumab survived without cancer progression for three years. That's compared to the 30% of patients who used more traditional refractory multiple myeloma treatments, such as the proteasome inhibitor bortezomib.
- Linvoseltamab (Lynozyfic). This bispecific antibody was approved in 2025 for multiple myeloma patients who received four previous treatments, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Scientists are currently studying linvoseltamab combined with other medicines, including the proteasome inhibitor carfilzomib.
- Talquetamab (Talvey). Talquetamab targets a protein made by multiple myeloma cells called GPRC5D. It is the first GPRC5D-targeted bispecific antibody. It was approved in 2023 for multiple myeloma patients who received four previous treatments, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Research found that 73% of patients responded for roughly nine to 10 months.
- Elranatamab (Elrexfio). Elranatamab was the second bispecific antibody to target the BCMA protein. Approved in 2023, the drug is an option for patients who received four previous treatments, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Trials show that 58% of patients responded to elranatamab. But there's a warning, because it can cause life-threatening side effects, such as neurologic toxicity.
Antibody Drug Conjugate
In 2025, the FDA approved belantamab mafodotin-blmf (Blenrep) for refractory multiple myeloma patients who received two previous treatments, including a proteasome inhibitor and immunomodulatory agent. This drug is an antibody drug conjugate, which combines targeted therapy with chemotherapy. It's a lab-made antibody that binds to a BCMA protein on cancer cells, and it delivers a dose of a chemotherapy drug to kill them. But the medicine can damage the eye, so doctors have to weigh the risks against the benefits.
Cereblon E3 ligase modulatory drugs (CELMoDs)
Cereblon E3 ligase modulatory drugs (CELMoDs) are a new drug class of medications for relapsed/refractory multiple myeloma that target specific proteins in cancer cells and break them down, helping to stop cancer cell growth and causing the cells to die.Iberdomide (Zenbexus) was recently FDA-approved in combination with daratumumab and hyaluronidase-fihj and dexamethasone (ZDd) for treatment of multiple myeloma in adults who have received at least one prior line of therapy including a proteasome inhibitor and an immunomodulatory agent.
Looking to the Future
Along with the recently approved and upcoming treatments, there are other new therapies in development.
- In vivo CAR T-cell therapies: Instead of removing the T cells and changing them in a lab, scientists are developing ways of turning T cells into CAR T cells in the body. "Data is still small, and more research is needed, but it's an exciting possibility," says Freeman. In vivo CAR T-cell therapies would cut down on the amount of time needed before treatment, since it takes two to three months to turn T cells into CAR T cells.
- New targets: Many of the existing therapies mark similar targets, such as the BCMA, CD38, XPO1, and BLC2 proteins. But researchers are looking at a variety of different pathways for targets, such as SLAMF7 for CAR T-cell therapies and SLC5A8.
Hope for Refractory Multiple Myeloma Patients
Over the past few years, scientists have made scientific breakthroughs and introduced new therapies for refractory multiple myeloma. It's a time of great hope, Gruenbaum says. If you have refractory multiple myeloma, talk to your cancer care team about these new treatments. You may also be a candidate for a clinical research trial, Gruenbaum says. "There are so many options for multiple myeloma currently."
