The treatment landscape for multiple myeloma (MM) is undergoing a major shift. As CAR-T cell therapy continues to demonstrate deep and durable responses, researchers are increasingly exploring whether it should move beyond relapsed or refractory disease and into earlier lines of treatment.
At the 10th CSCO Hematologic Oncology Congress, held in Harbin from July 10–12, 2026, Professor Juan Du of Renji Hospital, Shanghai Jiao Tong University School of Medicine, shared her perspective on this emerging trend, including the potential role of CAR-T in newly diagnosed and high-risk multiple myeloma.
From treating relapse to pursuing deeper, longer-lasting remission
CAR-T therapy has traditionally been used for patients with relapsed or refractory multiple myeloma. But according to Professor Du, moving CAR-T earlier in the treatment pathway could become an important direction for the field.
The goal is no longer simply to extend survival. Researchers are increasingly asking whether treatment can achieve exceptionally deep and durable disease control — potentially moving closer to functional cure.
This may be particularly important for patients with high-risk disease, who often require more effective strategies to achieve and maintain deep remission.
Professor Du’s team has been exploring a BCMA/CD19 dual-target CAR-T approach in newly diagnosed multiple myeloma. In data presented at the 2025 ASH Annual Meeting, 30 high-risk and elderly patients were treated and followed for a median of approximately three years.
The reported results were striking: the overall response rate (ORR) was 100%, the stringent complete response (sCR) rate reached 97%, and all patients achieved minimal residual disease (MRD) negativity. At approximately three years, both overall survival (OS) and progression-free survival (PFS) were around 90%.
While these results come from a relatively small clinical study and require confirmation in larger comparative trials, they add to the growing interest in using CAR-T earlier in the course of multiple myeloma.
Could CAR-T eventually replace transplant?
One of the most important questions now being investigated is whether CAR-T could eventually reduce or replace the role of autologous stem cell transplantation for selected newly diagnosed patients.
Large international Phase III studies are underway to address this question. Researchers are also examining whether CAR-T could be used as a finite treatment strategy, potentially offering patients durable disease control without the need for continuous therapy.
These studies could have major implications for how multiple myeloma is treated in the future.
Rather than reserving CAR-T for patients who have exhausted several treatment options, the field is moving toward a broader question: Can highly effective cellular therapy be used early enough to change the long-term course of the disease?
Dual targets and faster CAR-T manufacturing
Another important development is the evolution of CAR-T technology itself.
Multiple myeloma is a highly heterogeneous disease, and cancer cells can express different combinations of surface antigens. This has encouraged researchers to investigate multi-target CAR-T approaches, including dual-target strategies such as BCMA/CD19 CAR-T.
Manufacturing speed is another major consideration.
For patients with aggressive or rapidly progressing disease, waiting for conventional CAR-T manufacturing can be challenging. Shortening the interval between T-cell collection and infusion could therefore improve the feasibility of CAR-T treatment for patients who cannot afford a long waiting period.
Professor Du also highlighted the development of universal or allogeneic CAR-T platforms as another potential solution to the accessibility challenge. Moving from individualized autologous products toward more readily available cellular therapies could eventually make CAR-T treatment faster and more widely accessible.
The challenge of extramedullary disease and plasma cell leukemia
Not every form of multiple myeloma responds equally well to current treatments.
Extramedullary disease (EMD) and plasma cell leukemia represent particularly aggressive and difficult-to-treat forms of the disease. Future progress will require a better understanding of why myeloma cells develop these highly invasive characteristics.
According to Professor Du, identifying the molecular pathways that drive disease progression and discovering more specific therapeutic targets will be essential.
Such research could help scientists develop more effective CAR-T strategies for patients whose disease currently remains difficult to control.
From prolonging survival to pursuing cure
The broader evolution of multiple myeloma treatment is also being driven by other technologies, including bispecific antibodies, antibody-drug conjugates, CAR-T therapy, artificial intelligence and increasingly sophisticated MRD assessment.
Together, these advances are changing the way physicians think about treatment.
AI may help identify new therapeutic targets and improve risk stratification. More comprehensive MRD testing could allow clinicians to assess treatment response with greater precision. At the same time, new immunotherapies are expanding the number of options available to patients at different stages of disease.
For China, this represents an opportunity to move from following international developments to contributing new treatment strategies and clinical evidence of its own.
What could the next generation of myeloma treatment look like?
The direction is becoming increasingly clear: earlier intervention, deeper remission, more precise patient selection and increasingly personalized cellular therapy.
CAR-T is unlikely to remain confined to the relapsed/refractory setting forever. As ongoing trials provide more evidence, its role may expand into earlier lines of treatment, particularly for patients with high-risk disease.
The next major advances may come not from a single technology, but from combining better targets, faster manufacturing, MRD-guided treatment, AI-assisted risk stratification and new immune-based therapies.
For patients with multiple myeloma, the ultimate objective is straightforward: not simply to live longer, but to achieve long-lasting disease control with fewer treatment burdens.
CAR-T moving earlier could be one of the most important steps toward that goal.
The clinical data and expert perspectives summarized above are based on the interview and information provided from the 2026 CSCO Hematologic Oncology Congress. Individual treatment decisions should be made by qualified physicians based on a patient’s specific clinical condition.
