De-escalated Teclistamab dosing in relapsed/refractory multiple myeloma: Czech myeloma group real-world evidence analysis

Abstract

Teclistamab, a BCMA×CD3 bispecific antibody, demonstrates high efficacy in relapsed/refractory multiple myeloma (RRMM). However, optimal dosing strategies outside clinical trials remain undefined. Thus, we performed a retrospective, multicentre analysis of 73 RRMM patients treated with teclistamab monotherapy at Czech Myeloma Group centres between 2023 and 2025. The study compared efficacy and safety between patients receiving standard weekly dosing and those with reduced-frequency dosing. The whole cohort had a median age of 67 years; 68.5% were penta-refractory. Dosing was de-escalated in 24.7% of patients, typically within one month of treatment initiation. Median progression-free survival (PFS) was 9.41 months and was comparable between weekly and non-weekly groups (9.1 vs. 11.3 months; p = 0.141), despite a significantly lower relative dose intensity in the latter (60.5% vs. 87.0%; p < 0.001). Infection rates and severe adverse events were similar between groups. A lower incidence of neutropenia was observed with less frequent dosing, but this did not translate into reduced infection burden. In conclusion, in real-world practice, early de-escalation of teclistamab dosing appears to maintain clinical efficacy. These findings support ongoing efforts to individualize treatment schedules with the aim of balancing effectiveness, tolerability, and patient-specific factors in BCMA-targeted therapy.