Prognostic Factors Influencing the Efficacy and Safety of Teclistamab and Elranatamab in Multiple Myeloma: A Multicenter Propensity-Weighted Analysis

PURPOSE Bispecific antibodies (BsAbs) targeting B-cell maturation antigen show remarkable efficacy in relapsed/refractory multiple myeloma (rrMM), but real-world data on treatment failure and severe infections remain limited. MATERIALS AND METHODS This multicenter, retrospective study evaluated the efficacy, infection rates, and adverse events of BsAb therapy (teclistamab and elranatamab) in patients with rrMM, compared with a propensity score-matched historical control cohort. A total of 201 patients (148 teclistamab, 53 elranatamab) from 10 hospitals were analyzed alongside 162 matched controls. Outcomes included progression-free survival (PFS), overall survival (OS), infection rates, and adverse events, adjusted using inverse probability weighting. RESULTS Over a median follow-up of 13 months, the median PFS was 17.9 months in the BsAb cohort (not reached for teclistamab, 9.3 months for elranatamab). Grade ≥3 infections were significantly higher in BsAb-treated patients (98.2/100 patient-years v 27.1/100, P < .001), mostly bacterial or viral. Intensive care admissions were more frequent in BsAb patients. Teclistamab showed superior 12-month OS (73.4% v 53.9%, P < .05). Key adverse events included cytokine release syndrome (50.2%, 2% grade ≥3) and neurotoxicity (8.5%, 5.9% grade ≥3). CONCLUSION BsAb therapy improves rrMM outcomes but increases severe infection risk, necessitating proactive management. Teclistamab demonstrated a more favorable survival profile, highlighting the need for individualized treatment strategies.