Immunotherapy for multiple myeloma

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Immunotherapy is sometimes used to treat multiple myeloma. If you have immunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

CAR T-cell therapy takes millions of immune cells called T cells from a person with cancer. In the lab, the cells are changed so that they have chimeric antigen receptors (CARs) on their surface. These receptors recognize a specific antigen (protein) found on the type of cancer being treated. The T cells are then given back to the person where they multiply, attack and destroy the cancer cells.

Ciltacabtagene autoleucel (Carvykti) can be used to treat multiple myeloma that has been treated with at least 3 prior lines of treatment with targeted therapy drugs, such as a proteasome inhibitor, an immunomodulating drug or a monoclonal antibody, and did not respond to the most recent treatment (called refractory multiple myeloma). It can also be used to treat multiple myeloma that has been treated with 1 to 3 prior lines of treatment with a proteasome inhibitor and an immunomodulatory agent and did not respond to treatment with lenalidomide.

CAR T-cell therapy may not be available in all areas or covered by all provincial and territorial health plans.

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose, how it's given and your overall health. Tell your healthcare team if you have side effects that you think might be from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

CAR T-cell therapy may cause these side effects:

• cytokine release syndrome
• immune effector cell–associated neurotoxicity syndrome (ICANS)
• severe infection, including COVID-19
• nerve damage
• low blood cell counts
• flu-like symptoms, such as fever and chills
• fatigue
• nausea and vomiting
• diarrhea
• constipation
• cough
• shortness of breath
• low blood pressure
• second cancers

Bispecific antibodies are a new type of immunotherapy designed to attach to 2 different targets, an immune cell and a cancer cell, bringing the 2 cells together to help the body's immune system attack the myeloma cells.

Bispecific T-cell engagers (BiTEs) are a type of bispecific antibody used in the treatment of multiple myeloma. They work by attaching to the CD3 protein on T cells and to a specific protein on myeloma cells, such as the B-cell maturation antigen (BCMA).

Teclistamab (Tecvayli) or elranatamab (Elrexfio) can be used to treat relapsed or refractory multiple myeloma that has been treated with at least 3 prior lines of treatment with targeted therapy drugs, such as a proteasome inhibitor, an immunomodulating drug or a monoclonal antibody, and did not respond to the most recent treatment (called refractory multiple myeloma).

Bispecific antibodies may not be available in all areas or covered by all provincial and territorial health plans.

Teclistamab and elranatamab may cause these side effects:

• cytokine release syndrome
• immune effector cell–associated neurotoxicity syndrome (ICANS)
• nerve damage
• severe infection, including COVID-19
• low blood cell counts
• fatigue
• pain in the abdomen
• diarrhea
• nausea and vomiting
• pain at the injection site
• fever
• swelling

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.