Comparative efficacy and safety of bispecific antibody teclistamab versus CAR-T cell therapies in relapsed/refractory multiple myeloma: a retrospective evaluation.

To compare the clinical efficacy, safety, and cost-effectiveness of bispecific antibody teclistamab and chimeric antigen receptor T-cell (CAR-T) therapy in relapsed/refractory multiple myeloma (RRMM) to guide individualized treatment. This retrospective study enrolled 67 RRMM patients (excluded 6 of 73) hospitalized at Xinxiang Central Hospital (December 2024-May 2025), divided into teclistamab (n=32) and CAR-T (n=35) groups. Primary outcomes included overall response rate (ORR) and progression-free survival (PFS). Secondary outcomes comprised complete response rate (CRR), duration of response (DOR), minimal residual disease (MRD) negativity rate, overall survival (OS), adverse events (AEs), hospital stays, direct medical costs, and cost-effectiveness ratio (CER). The CAR-T group showed higher CRR (P=0.011), ORR (P=0.029), MRD negativity rate (P=0.027), longer median DOR [HR: 3.35 (1.838, 6.10), P<0.001], PFS [HR: 4.407 (1.994, 9.74), P<0.001], and better OS (HR: 3.204 (1.015, 10.1), P=0.021) than the teclistamab group. However, the CAR-T group had higher incidences of cytokine release syndrome (P=0.033) and hematological AEs (P=0.040), longer hospital stays, higher direct costs, and higher CER (all P<0.001). Prior treatment lines were independent prognostic factors (P=0.036). CAR-T therapy outperforms teclistamab in efficacy and survival outcomes but has higher AEs and costs. Teclistamab demonstrates superior safety and shorter hospital stays, supporting individualized clinical selection.