Saudi experts statement on advancing multiple myeloma treatment: the evolving role of bispecific antibodies.

Introduction: The therapeutic landscape in multiple myeloma (MM) is rapidly evolving; however, a significant unmet need remains for patients with relapsed or refractory (RR) MM in Saudi Arabia. Although chimeric antigen receptor T-cell (CAR-T) therapies for myeloma have received approval in the region, their accessibility remains limited, and many patients are ineligible due to factors such as advanced age, comorbidities, rapidly progressive disease, or logistical barriers. Bispecific antibodies (BsAbs) are emerging as a promising option in Saudi Arabia, but the paucity of region-specific clinical evidence underscores the critical need for tailored, evidence-based guidance to optimize their application in clinical practice. Methods: A group of experts in MM based in Saudi Arabia convened to align on optimal use of BsAbs in clinical practice based on their experience and evidence from a literature analysis. A modified Delphi methodology with prespecified acceptance threshold of ≥70% was used to generate expert recommendations. Results: Agreement was achieved in 30 of 35 statements (86%) across four broad areas: patient selection, sequencing and dosing, monitoring, and efficacy outcomes. Experts agreed that BsAbs should be positioned in triple-class refractory MM. Positive clinical trial outcomes observed with BsAbs, including high overall response rates, prolonged progression-free survival and overall survival underscore the importance of selecting BsAbs with proven efficacy. While CAR T-cell therapy is only recently approved for MM in Saudi Arabia, BsAbs are preferred for patients with rapidly progressing disease due to CAR T-cell product manufacturing delays. Conclusion: BsAbs are an effective treatment option for those with triple-class refractory MM and this manuscript provides a framework to support their optimal use in Saudi Arabia.