Understanding REALiTEC: Real-World Insights on BCMA Bispecifics
An expert explains that real-world data from the REALiTEC study shows teclistamab remains highly effective in relapsed/refractory multiple myeloma—even among patients ineligible for clinical trials—demonstrating strong response rates, encouraging survival outcomes, and reinforcing the importance of therapy sequencing and broad access to bispecific antibodies in everyday clinical practice.
Real-world data from recent analyses such as the REALiTEC study has offered valuable insights into the effectiveness of bispecific antibody therapy, specifically teclistamab, in treating relapsed/refractory multiple myeloma. This retrospective study involved 113 patients across multiple countries and medical centers, revealing that 69% of participants would not have qualified for the original clinical trial (MajesTEC-1) due to various exclusion criteria. Despite this, the overall response rate reached 60%, with over half of the patients achieving a very good partial response or better. These results are notable given the heavily pretreated nature of the cohort, with a high proportion being triple- or penta-refractory.
The durability of response was also encouraging, with a median progression-free survival of 9.7 months and overall survival of 26.2 months. Importantly, patients who had not received prior B-cell maturation antigen (BCMA)–targeting antibody-drug conjugates demonstrated particularly strong responses, suggesting sequencing of therapies could play a significant role in outcomes. Even among patients previously treated with BCMA-targeted CAR T or antibody-drug conjugates, teclistamab remained effective, albeit with slightly lower response rates. This real-world evidence supports the feasibility and effectiveness of bispecific antibodies in broader patient populations who may not meet strict clinical trial eligibility.
One of the most compelling takeaways from this analysis is how closely real-world outcomes mirrored those observed in clinical trials, challenging the assumption that trial efficacy often diminishes in routine clinical settings. It also highlights the global applicability of teclistamab across different health care systems. These findings affirm the growing role of bispecific antibodies as a standard treatment option for patients with relapsed/refractory multiple myeloma and underscore the importance of expanding access and refining treatment sequencing strategies to optimize outcomes for all patients, not just those who meet rigid trial criteria.
