{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:29:58Z","timestamp":1786595398204,"version":"build-2736575974"},"reference-count":50,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: The treatment landscape of relapsed\/refractory multiple myeloma (RRMM) has significantly evolved with the introduction of novel classes of agents and, more recently, of T-cell-redirecting therapies, including bispecific antibodies (BsAbs). It is essential to enhance and harmonize the therapeutic management of BsAbs within clinical practice. Methods: We performed a modified Delphi expert consensus study on the use of BsAbs targeting the B-Cell Maturation Antigen (BCMA) in patients with triple-class-exposed (TCE) RRMM. The study was conducted in April\u2013November 2025 following established guidelines and best practices for defining consensus. The key phases in the use of anti-BCMA BsAbs were identified and explored. Results: Fifteen Italian hematologists with expertise in the care of TCE RRMM completed two Delphi rounds. Agreement (defined as \u226567% of panelists) was achieved on most of the topics evaluated. In particular, all panelists considered the step-up dosing phase feasible in an outpatient setting, under specific circumstances, and dosing de-escalation in responding patients to reduce the risk of adverse events. For most of them, anti-BCMA BsAb treatment is also feasible in several challenging subgroups, including frail patients (93% agreement) and those with high-risk cytogenetics (93%), extramedullary disease (93%), end-stage renal disease (86%), active plasma cell leukemia (79%), and central nervous system involvement (67%). In addition, agreement (93%) was reached on the possible sequential use of BCMA-targeting therapies, preferentially BsAbs following CAR-T, though a switch in the target antigen should primarily be considered. Conclusions: In this article, we address the main challenges related to the real-world use of anti-BCMA BsAbs in patients with TCE RRMM, offering expert recommendations to complement existing guidelines and support clinical practice.<\/jats:p>","DOI":"10.3390\/cancers18162572","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T16:35:16Z","timestamp":1786379716000},"page":"2572","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing the Real-World Use of BCMA-Targeted T-Cell-Engaging Therapies in Patients with Triple-Class-Exposed Relapsed\/Refractory Multiple Myeloma: An Italian Modified Delphi Consensus"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4514-3227","authenticated-orcid":false,"given":"Michele","family":"Cavo","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Bersanelli","sequence":"additional","affiliation":[{"name":"Pfizer Italia, 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Corso","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplantation Division, Hospital Legnano, 20025 Legnano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1934-5167","authenticated-orcid":false,"given":"Carlotta","family":"Galeone","sequence":"additional","affiliation":[{"name":"Bicocca-Applied Statistics Center (B-ASC), Department of Economics, Management and Statistics, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-3083","authenticated-orcid":false,"given":"Silvia","family":"Mangiacavalli","sequence":"additional","affiliation":[{"name":"U.O.C. Ematologia 1, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8144-541X","authenticated-orcid":false,"given":"Roberto","family":"Mina","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Molecular Biotechnology and Health Sciences, AOU Citt\u00e0 della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-5324","authenticated-orcid":false,"given":"Renato","family":"Zambello","sequence":"additional","affiliation":[{"name":"Dipartimento di Medicina (DIMED), Ematologia e Immunologia Clinic, Universit\u00e0 di Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Antonioli","sequence":"additional","affiliation":[{"name":"Haematology Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0617-3127","authenticated-orcid":false,"given":"Angelo","family":"Belotti","sequence":"additional","affiliation":[{"name":"Department of Hematology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-4504","authenticated-orcid":false,"given":"Cirino","family":"Botta","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2019Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Buda","sequence":"additional","affiliation":[{"name":"Ematologia Univ, Dipartimento di Medicina Clinica e Sperimentale, Universit\u00e0 di Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Raimondo","sequence":"additional","affiliation":[{"name":"A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Dipartimento di Specialit\u00e0 Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Universit\u00e0 degli Studi di Catania, 95131 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2192-9460","authenticated-orcid":false,"given":"Monica","family":"Galli","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8619-412X","authenticated-orcid":false,"given":"Francesca","family":"Gay","sequence":"additional","affiliation":[{"name":"Division of Hematology 1, Azienda Ospedaliero-Universitaria Citt\u00e0 della Salute e della Scienza di Torino, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2749-7347","authenticated-orcid":false,"given":"Massimo","family":"Offidani","sequence":"additional","affiliation":[{"name":"Clinica di Ematologia, AOU delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0688-4882","authenticated-orcid":false,"given":"Maria Teresa","family":"Petrucci","sequence":"additional","affiliation":[{"name":"Hematology, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza University of Rome, 00161 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-4433","authenticated-orcid":false,"given":"Alessandra","family":"Romano","sequence":"additional","affiliation":[{"name":"A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Dipartimento di Specialit\u00e0 Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Universit\u00e0 degli Studi di Catania, 95131 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-7305","authenticated-orcid":false,"given":"Elena","family":"Zamagni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"},{"name":"Istituto di Ematologia \u201cSer\u00e0gnoli\u201d, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Semeraro","sequence":"additional","affiliation":[{"name":"Pfizer Italia, 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Veggia","sequence":"additional","affiliation":[{"name":"Pfizer Italia, 00188 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Mariani","sequence":"additional","affiliation":[{"name":"Bicocca-Applied Statistics Center (B-ASC), Department of Economics, Management and Statistics, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-024-00529-7","article-title":"Multiple myeloma","volume":"10","author":"Malard","year":"2024","journal-title":"Nat. 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