{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T05:44:46Z","timestamp":1794635086874,"version":"4.9.1"},"reference-count":33,"publisher":"American Society of Hematology","issue":"25","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,18]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Bispecific T-cell engagers (TCEs) targeting B-cell maturation antigen (BCMA) and CD3, induce deep hematologic responses in \u223c60% of heavily pretreated patients with multiple myeloma (MM). We and others found that high tumor burden leads to resistance to TCE and novel strategies are urgently needed to improve responses in this setting. Ikaros degraders, including immunomodulatory drugs (IMiDs) and cereblon E3 ligase modulatory drugs (CELMoDs), represent logical partners for TCEs due to their direct anti-MM effects and additional immune-stimulatory activity; however, it is unclear how to optimally combine them with TCEs. Taking advantage of the immunocompetent IMiD-sensitive Vk\u2217MYChCRBN murine model of MM, we optimized strategies to overcome primary resistance to BCMA-TCEs and achieve sustained remission, while maintaining a manageable safety profile. The addition of anti\u2013programmed cell death protein 1 (PD1) and pomalidomide reduced the T-cell exhaustion that occurs in response to TCEs in high tumor burden settings. This allowed for a higher degree of T-cell activation and significant improvement in response rates but also increased risk of lethal cytokine release syndrome (CRS). To moderate the response and prevent CRS, we evaluated Ikaros degraders and dexamethasone (DEX) with step-up\u2013dosed TCEs. Pretreatment with iberdomide and DEX reshaped the bone marrow T-cell compartment, promoted infiltration of na\u00efve T cells, and generated 100% response rates and the longest survival in subjects with high tumor burden. This was accompanied by more favorable T-cell profiling, with limited expansion of regulatory T cells and exhaustion. Overall, administering a TCE after DEX and iberdomide treatments provided deeper and more durable responses with a reduced risk of CRS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1182\/blood.2025029215","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:21:13Z","timestamp":1756322473000},"page":"3072-3085","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":13,"title":["An immunostimulatory CELMoD combination overcomes resistance to T-cell engagers caused by a high multiple myeloma burden"],"prefix":"10.1182","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-7624","authenticated-orcid":false,"given":"Erin W.","family":"Meermeier","sequence":"first","affiliation":[{"name":"1Department of Immunology, Mayo Clinic Arizona, Scottsdale, AZ"},{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb K.","family":"Stein","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3128-4517","authenticated-orcid":false,"given":"Meaghen E.","family":"Sharik","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-4837","authenticated-orcid":false,"given":"Megan T.","family":"Du","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2626-1227","authenticated-orcid":false,"given":"Yuliza","family":"Tafoya Alvarado","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Xin","family":"Shi","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0779-7756","authenticated-orcid":false,"given":"Yuan Xiao","family":"Zhu","sequence":"additional","affiliation":[{"name":"2Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1523-7388","authenticated-orcid":false,"given":"P. 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