Real-world outcomes of ide-cel and cilta-cel in relapsed/refractory multiple myeloma: A nationwide, retrospective analysis in Austria

B-cell maturation antigen-directed chimeric antigen receptor (CAR) T cells have revolutionized the treatment of relapsed/refractory multiple myeloma. However, no randomized head-to-head comparison of idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) is available, and real-world data suggest differences in efficacy and toxicity. We performed a nationwide retrospective real-world analysis (RWA) of Austrian patients treated with ide-cel or cilta-cel between January 2024 and July 2025. Ninety patients were included, with largely balanced baseline characteristics and frequent high-risk features. Bridging therapy was administered to 94.4% of patients, resulting in high response rates prior to lymphodepletion. After a median follow-up of 17.6 months, no early separation of the progression-free survival (PFS) curves was observed between CAR-T products. Multivariable analyses showed a trend towards improved PFS with cilta-cel, whereas true extra-medullary disease (EMD) and prior bispecific antibody treatment before T-cell apheresis were associated with inferior PFS. Although previous RWA have demonstrated an early divergence in PFS between cilta-cel and ide-cel, this pattern was not observed in our cohort. The high effectiveness of bridging therapy may have contributed to these findings. Our results support further investigation of optimal bridging strategies and treatment sequencing while highlighting the persistent unmet need of patients with true EMD.