From Trials to Practice: A 2025 Review of Idecabtagene Vicleucel and Ciltacabtagene Autoleucel Efficacy Across Clinical Studies and Real-World Evidence.

B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapies have revolutionized the approach and management of relapsed/refractory multiple myeloma (RRMM), and as of 2025, idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) are the only BCMA-targeted CAR T-cell therapies approved by the FDA. Exceptional responses were demonstrated for heavily pretreated patients in the KarMMa-1 trial, reporting a 73% overall response rate (ORR) and 98% in the CARTITUDE-1 trial. Furthermore, both therapies show a significant improvement in progression-free survival (PFS) compared to standard regimens when administered in earlier lines. Current real-world evidence confirms their effectiveness and manageable safety in a more diverse patient population, including those who would have been ineligible for clinical trials. Key toxicities include cytokine release syndrome (CRS) and neurotoxicity, with emerging concerns regarding delayed neurotoxicities, second primary malignancies, and IEC-enterocolitis. This review provides a detailed analysis of recent clinical trial data, the reported outcomes of real-world published evidence, and the changing role of these therapies within the myeloma treatment paradigm, including challenges, gaps in knowledge, potential barriers to accessibility, and future directions aimed at optimizing the efficacy and safety of CAR T-cell therapy for MM patients.