Treatment of Triple-Class Refractory Multiple Myeloma When Disease Is Also Refractory to CAR T Cells or an Antibody-Drug Conjugate

This protocol applies to patients with multiple myeloma that is triple-class refractory and whose disease has also progressed after CAR T-cell therapy or after an antibody-drug conjugate (ADC). This combination of prior treatment failures defines a heavily pre-treated population facing a narrow set of remaining therapeutic avenues.

Triple-class refractoriness combined with CAR T or ADC failure represents one of the most challenging presentations in myeloma management. Treatment selection in this setting requires careful consideration of individual prior exposure and patient-specific factors, as options are limited and agent sequencing matters.

Bispecific T-cell-engaging antibodies targeting myeloma antigens are among the evaluated approaches in this setting. When preferred agents are not available or appropriate, additional salvage options may be considered. The complete protocol specifies the full selection criteria, sequencing logic, and contingency regimens.

Full agent selection, sequencing, and dosing details are available in the structured protocol.