CAR T-cell therapy moving to frontline as myeloma treatment
Report says most doctors see therapies becoming standard 1st-line treatment
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Most doctors who treat multiple myeloma expect that CAR T-cell therapies will soon became the standard first-line treatment, according to new research from market analytics company Spherix Global Insights.
The trend marks a shift in attitudes among myeloma experts. Last year, doctors tended to report more complexity in navigating a rapidly increasing arsenal of myeloma treatments. The new data “suggest physicians are no longer simply navigating complexity, but actively recalibrating how and when to deploy their most potent therapies,” Spherix said in a company press release.
T-cells are immune cells that have the ability to kill cancerous cells. CAR T-cells are a recent class of cancer treatment that involves arming T-cells with a chimeric antigen receptor, or CAR, a human-made protein that directs the T-cells to attack a specific target.
Recently approved CAR T-cell therapies for myeloma, such as Abecma (idecabtagene vicleucel) and Carvykti (ciltacabtagene autoleucel), are designed to bind to the BCMA protein, which is found at high levels on the surface of myeloma cells.
These products are also autologous, meaning they involve collecting a patient’s own T-cells. The cells are taken to a lab to equip them with the CAR, then transferred back into the patient.
Treatment ‘entering a new phase’
When CAR T-cell therapies were first approved, they were generally reserved only for myeloma patients who had failed to respond to other treatments. Spherix’s data indicate that doctors are increasingly prioritizing more potent and durable responses earlier in the disease course, which means these therapies will soon be the main option as a first-line treatment for myeloma.
In a survey of 99 U.S. oncologists and hematologists conducted in early 2026, almost three-quarters of respondents agreed that CAR T-cell therapies “will eventually become a first-line standard of care.”
“Taken together, the Q1 2026 findings suggest that the [multiple myeloma] treatment paradigm is entering a new phase: one defined not just by expanding options, but by a willingness to rethink long-standing sequencing conventions,” Spherix said. “As CAR-T continues its shift toward earlier lines of therapy, the key question is no longer whether it will play a central role, but how quickly clinical practice and infrastructure can evolve to support its broader adoption.”
The company said logistical barriers related to CAR T-cell treatment are becoming less of a hurdle, as more clinicians gain familiarity with these therapies and report feeling comfortable with taking patients through the autologous treatment protocol.
And CAR T-cells are becoming increasingly common as an early treatment option for myeloma. According to Spherix, the proportion of patients receiving CAR T-cells as a second-line treatment is expected to rise from 14% currently to 24% in the next six months. The use of CAR T-cells in third-line treatment is also expected to increase, from roughly 23% to 28%.
In myeloma patients whose cancer fails to respond to multiple prior lines of treatment, “the competitive dynamics remain more complex,” Spherix said. In these patients, the go-to therapies are bispecific antibodies, which are designed to simultaneously bind to cancer cells and to T-cells to facilitate immune responses against the cancer.
Still, CAR T-cell therapy “maintains a strong and growing presence” as a fourth-line treatment, Spherix said. “Together, these findings suggest that while bispecifics are firmly entrenched, [CAR T-cell therapy] is increasingly viewed as a complementary, or in some cases preferred, option for select patients.”
The company noted that a major unanswered question among myeloma clinicians is whether patients should undergo treatment with bispecifics before they receive CAR T-cell therapies. This highlights continued uncertainty about exactly how best to deploy these new, powerful therapies, according to Spherix.
