{
  "abstract": "Background: Chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAbs) have transformed treatment for relapsed/refractory multiple myeloma (RRMM). Contemporary guidelines increasingly incorporate prior antigen-directed exposure, disease kinetics, patient fitness, toxicity, access, and patient preference. However, a prospectively validated framework that jointly operationalizes immune fitness, tumor antigen status, and treatment feasibility for sequencing T-cell–redirecting therapies is not available.\n\nMain body: This Perspective introduces the Adaptive Immunotherapy Sequencing Model (AISM), an author-proposed framework for research and multidisciplinary discussion. AISM proposes that sequencing should be studied in relation to two evolving biological domains: the capacity of the host T-cell compartment to support therapy and the probability that the relevant tumor antigen remains therapeutically actionable. The model uses provisional 0–10 research constructs for T-cell fitness and antigen-escape risk to make these domains explicit. AISM hypothesizes that, for eligible patients with early RRMM and feasible access, referral for BCMA-directed CAR-T before prolonged exposure to T-cell–redirecting BsAbs may preserve a potentially favorable treatment option. It also recognizes that off-the-shelf BsAbs may be necessary when disease tempo, frailty, access, or patient preference make CAR-T impracticable. After prior BCMA-directed therapy, an antigen-switching approach is biologically plausible, but antigen loss is not universal and other mechanisms of resistance must be considered.\n\nConclusions: AISM provides a testable framework for prospective comparative studies. Such studies should evaluate whether biologically informed sequencing improves progression-free survival (PFS), while also assessing overall survival, toxicity, infections, treatment-free time, feasibility, and patient-reported outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hemato-Oncology, Al-Quds University School of Medicine"
  ],
  "article_type": "review",
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Aliaa Khalili"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/17gy9skrhrgsv.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1897153",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716753/?tool=EBI",
  "id": "17gy9skrhrgsv",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1897153/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Perspective"
    ],
    [
      "openalex",
      "2720|Multiple Myeloma Research and Treatments"
    ]
  ],
  "openalex": "W7221928812",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1897153/pdf",
  "pmcid": "PMC13716753",
  "pmid": "42959251",
  "published": "2026-10-15",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/17gy9skrhrgsv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.1897153",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1897153/full"
    },
    {
      "first_seen": "2026-10-31T00:20:37Z",
      "native_id": "PMC:PMC13716753",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13716753"
    },
    {
      "first_seen": "2026-11-01T00:20:52Z",
      "native_id": "MED:42959251",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42959251"
    },
    {
      "first_seen": "2026-11-01T12:23:58Z",
      "native_id": "PMC13716753",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.1897153"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "Rethinking immunotherapy sequencing in multiple myeloma: a conceptual adaptive immunotherapy sequencing model",
  "title_text": "Rethinking immunotherapy sequencing in multiple myeloma: a conceptual adaptive immunotherapy sequencing model",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:21:12Z",
  "url": "https://research.draconitic.com/paper/17gy9skrhrgsv",
  "venue": "Frontiers in Immunology",
  "versions": []
}