肿瘤细胞治疗研究
英文原题：Real-world analyses of bispecific antibodies and CAR-T cell therapy in relapsed or refractory multiple myeloma: a global TriNetX discovery and contemporary validation cohort.
Real-world analyses of bispecific antibodies and CAR-T cell therapy in relapsed or refractory multiple myeloma: a global TriNetX discovery and contemporary validation cohort.
BsAbs 治疗相比 CAR-T 显示出更差的总生存期（HR 2.015，95% CI 1.592-2.551；p < 0.001），在多个生化风险亚组中观察到相似信号。
双特异性抗体（BsAbs）和靶向BCMA的CAR-T细胞疗法已改变了晚期复发/难治性多发性骨髓瘤（RRMM）的治疗格局，但真实世界比较受到治疗选择、治疗线数和支持治疗的混杂影响。我们将全球倾向性匹配的TriNetX探索性分析与一个当代、考虑治疗线数的验证队列相结合。在TriNetX中，截至2026年4月8日共识别出223,703例骨髓瘤患者，匹配后得到822例接受BsAb治疗和822例接受CAR-T治疗的患者。BsAbs治疗的总生存期劣于CAR-T（HR 2.015，95% CI 1.592-2.551；p < 0.001），在多个生化风险亚组中观察到相似信号。Cilta-cel优于ide-cel，而teclistamab与talquetamab相当。在验证队列（187例患者，211次暴露）中，CAR-T治疗使用得更早，且用于体能状态更好的患者。在考虑暴露和更后线疾病后，类别层面的OS和TTNT差异减弱，而cilta-cel仍在数值上更有利。总体而言，治疗选择应个体化，而非按类别优先。
Bispecific antibodies (BsAbs) and BCMA-directed CAR-T cell therapies have transformed late-line relapsed/refractory multiple myeloma (RRMM), yet real-world comparisons are confounded by treatment selection, line of therapy, and supportive care. We combined a global propensity-matched TriNetX discovery analysis with a contemporary, treatment-line-aware validation cohort. In TriNetX, 223,703 myeloma patients were identified up to 8 April 2026, matching yielded 822 BsAb- and 822 CAR-T-treated patients. BsAbs therapy showed inferior overall survival versus CAR-T (HR 2.015, 95% CI 1.592-2.551; p < 0.001), with similar signals in several biochemical risk subgroups. Cilta-cel outperformed ide-cel, whereas teclistamab and talquetamab were comparable. In the validation cohort (187 patients, 211 exposures), CAR-T therapy was used earlier and in fitter patients. After accounting for exposure and later-line disease, class-level OS and TTNT differences attenuated, while cilta-cel remained numerically favorable. Overall, treatment selection should be individualized rather than class-preferential.
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