Chimeric Antigen Receptor T-cell Therapy in Multiple Myeloma: Potential Benefits and Key Challenges to Becoming a Standard Treatment

Background: Multiple myeloma (MM) remains an incurable haematological malignancy, with most patients experiencing relapse owing to drug resistance despite advances in proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and autologous or allogeneic stem cell transplantation. Chimeric Antigen Receptor T-cell (CAR-T cell) therapy has emerged as a highly promising immunotherapeutic agent, particularly when targeting B-cell maturation antigen (BCMA). Methods: A narrative literature review was conducted using PubMed, MEDLINE, and Embase to identify relevant studies published between 2013 and 2025. Search terms included ‘CAR-T’, ‘multiple myeloma’, ‘BCMA’, ‘idecabtagene vicleucel’, and ‘ciltacabtagene autoleucel’. Additional grey literature was obtained from regulatory agencies (FDA, NICE) and cancer statistics (SEER). Eligible studies included phase I-III clinical trials, systematic reviews, meta-analyses, review articles, and policy documents in English. Case reports, non-peer-reviewed conference abstracts, and non-English studies were excluded. Results: FDA-approved, BCMA-directed CAR-T cell therapies such as idecabtagene vicleucel and ciltacabtagene autoleucel have shown unprecedented response rates in patients with relapsed/refractory MM, with overall response rates of 73% and 98% respectively. However, challenges such as antigen escape, CAR-T cell exhaustion, high manufacturing costs and accessibility challenges have limited their widespread use. Adverse effects such as cytokine release syndrome, neurotoxicity, and prolonged immunosuppression further complicate its integration into clinical practice. Discussion: CAR-T cell therapy represents potential for tangible improvement in the relapsed/refractory treatment landscape. Compared to conventional therapies, CAR-T cell therapy offers durable remission, particularly in heavily pretreated patients, and more precise targeting of tumour cells. Future research should focus on optimising CAR-T cell persistence, exploring dual- or multi-antigen targeting and developing more efficient, decentralised manufacturing processes. Bridging the gap between innovation and accessibility is critical for the feasible implementation of CAR-T cell therapy as a standard treatment for MM. Broader integration into treatment algorithms requires addressing financial and ethical barriers to ensure equitable access.