BiTE Therapy for Myeloma: How Bispecific Antibodies Work

Medically reviewed by Alfredo Chua, M.D.

Written by Emily Wagner, M.S. and Emily Van Devender

Updated on October 1, 2026

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Key Takeaways

Bispecific T-cell engagers, or BiTEs, are a newer type of immunotherapy that work by bringing the body's own immune cells close to multiple myeloma cancer cells so they can attack them.
BiTE therapies are currently used for people with relapsed or refractory multiple myeloma, meaning the cancer has come back or stopped responding to other treatments. As of 2026, four BiTE therapies have been approved by the FDA, and clinical trials have shown that many people with this condition respond to these drugs.
If you or someone you know has relapsed or refractory multiple myeloma, talking with a cancer care team is a great first step to learning whether BiTE therapy could be an option, and to ask questions about the possible benefits and side effects of each available treatment.

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Your immune system helps protect your body from threats like bacteria and viruses. It produces protective proteins called antibodies that recognize specific targets. Scientists have found ways to use antibodies to help the immune system attack multiple myeloma cells.

Bispecific T-cell engagers (BiTEs) are a newer type of immunotherapy used to treat relapsed or refractory multiple myeloma (RRMM). They bring T cells close to myeloma cells so the T cells can attack them. We’ll cover how bispecific antibodies work, when they might be recommended, and which ones are available to treat RRMM.

How Does BiTE Therapy Work?

Monoclonal antibodies are biologic drugs made in a lab to bind to specific targets in the body. The prefix “bi” means “two,” and bispecific antibodies are designed to bind to two different targets at the same time.

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Antibodies are Y-shaped proteins that attach to specific targets. Some treatments are designed to help immune cells called T cells, or T lymphocytes, recognize and attack cancer cells.

One target is always CD3, a protein found on T cells that plays a key role in T-cell activation. The other target is a protein found on myeloma cells. The target depends on the specific antibody you receive.

Scientists are also studying BiTEs as treatments for other blood cancers, including some types of lymphoma and leukemia.

When Might Doctors Recommend BiTE Therapy?

Although standard myeloma treatments like immunomodulatory drugs or immunotherapies are often effective at first, many people eventually experience a relapse.

“Relapsed” means that the cancer comes back after responding to treatment. “Refractory” means the cancer becomes resistant or stops responding to treatment.

Currently, BiTE drugs are used for people with relapsed or refractory multiple myeloma. Some may be an option for people with RRMM who’ve tried at least four prior lines of therapy, including drugs in the following categories:

A proteasome inhibitor
An immunomodulatory agent
An anti-CD38 monoclonal antibody

BiTEs may be an option for people with RRMM who’ve tried at least four prior lines of therapy.

Researchers are looking into whether BiTE therapies may help earlier in therapy or when combined with other treatments. Future BiTE therapies may target other cell receptors, providing more treatment options for people with RRMM.

What BiTE Therapies Are Approved for Relapsed or Refractory Myeloma?

As of 2026, four BiTE therapies are approved by the U.S. Food and Drug Administration (FDA) for adults with RRMM. Others continue to be studied in clinical trials and may receive approval in the coming years.

If you’re a candidate for BiTE therapy for RRMM, you and your doctor will decide on a treatment plan together through shared decision-making. Your doctor will consider your treatment history, overall health, and personal preferences. Once you start a new treatment, your doctor will monitor how well it’s working and watch for serious side effects.

Teclistamab-Cqyv

The first BiTE approved by the FDA was teclistamab-cqyv (Tecvayli) in 2022. It targets a protein called B-cell maturation antigen (BCMA), which is found on myeloma cells. This makes it a BCMA-targeted therapy.

Teclistamab-cqyv is given as an injection using gradually increasing dosages at the start of treatment. It was also approved in 2026 in combination with daratumumab hyaluronidase-fihj (Darzalex Faspro) for adults with RRMM who have received at least one other treatment that included a proteasome inhibitor and an immunomodulatory agent.

Elranatamab-Bcmm

Elranatamab-bcmm (Elrexfio) was approved for the treatment of RRMM in 2023 as a BCMA-targeted therapy. It’s also given in increasing dosages, starting with injections every few days and later becoming less frequent. For people who continue to respond, this medication may eventually be given every two to four weeks.

Linvoseltamab-Gcpt

Linvoseltamab-gcpt (Lynozyfic) was approved in 2025 for treating RRMM. This medication is also a BCMA-targeted therapy for adults.

Given as an infusion, the dose is gradually increased at the start of treatment and later given less often. If your doctor determines you respond well to it, eventually you can receive infusions every four weeks.

Talquetamab-Tgvs

Talquetamab-tgvs (Talvey), approved in 2023, works a little differently. It isn’t a BCMA-targeted therapy like the other three approved options.

Talvey binds to a different type of protein on myeloma cells — G-protein-coupled receptor family C, group 5, member D (GPRC5D). BiTEs that target GPRC5D are called non-BCMA-directed therapies.

Talquetamab-tgvs is given as an injection starting at a low dose that’s increased over the first week or two. The medication can be given once weekly or once every two weeks, depending on your doctor’s recommendations.

How Effective Is BiTE Therapy?

The FDA approves new drugs based on evidence from clinical trials — carefully designed studies that test how well a treatment works and how safe it is. One key measure is called overall response rate (ORR), which is the percentage of people whose cancer shows a partial or complete response to treatment.

Although there’s no cure for myeloma, BiTEs have shown promise in treating RRMM. Below are highlights from clinical trials of BiTE drugs.

Teclistamab-Cqyv Results

The ORR was 61.8 percent.
At nine months, 66.5 percent of people who responded were still in response.

An additional analysis found that people taking teclistamab-cqyv had better progression-free survival (PFS) and overall survival (OS) compared with people receiving other therapies. PFS refers to the time until cancer gets worse, and OS is how long people live after starting treatment.

Elranatamab-Bcmm Results

The ORR was 57.7 percent.
About 26 percent of people had at least a complete response.
About 82 percent of responders were still in response after nine months.

Linvoseltamab-Gcpt Results

The ORR was 70 percent.
About 45 percent of people had at least a complete response.
About half of responders had a response within one month, but for some it took up to six months.
Almost 90 percent of responders were still in response at nine months, and 72 percent were still in response after one year.

Talquetamab-tgvs Results

The ORR was about 73 percent.
About 32 percent of people had at least a complete response, based on pooled data from different dosing schedules.
Most responses began in a little more than a month.
An estimated 85 percent of responders receiving the every-two-week dose were still in response at nine months.

These trial results show that many people with relapsed or refractory multiple myeloma respond to BiTE drugs. Your myeloma specialist can help explain whether BiTE therapies could be a good choice for your treatment plan, either now or in the future.

Results from clinical trials show that many people with relapsed or refractory multiple myeloma respond to BiTE drugs.

Discuss Your Options With Your Cancer Care Team

With new immunotherapies becoming available, it’s important to talk with your cancer care team about your treatment plan. Be sure to ask questions about your options for RRMM treatment. Your cancer care team can help you weigh the benefits and potential risks, including side effects, of each treatment option.

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I had my step up treatments in May of 2025 of Elrexfio a newer bi-specific for BCMA and C-3. My blood test one week later was MRD-. Light chains were less than 1 and no M-spike detected. I am still in… read more