While the introduction of proteasome inhibitors, immunomodulators and monoclonal antibodies targeting CD38 have revolutionized the treatment of multiple myeloma, many patients become refractory to these agents. The B-cell maturation agent (BCMA) is expressed on 100% of plasma cells but not on immature hematopoietic cells or other normal tissue and has emerged as a novel target for immunotherapy in multiple myeloma. Agents targeting BCMA have been shown to significantly improve outcomes in triple-refractory patients. These agents include two CAR-T therapies, idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), currently under regulatory review with the FDA for triple-refractory multiple myeloma and the antibody-drug conjugate belantamab mafodotin, approved in 2020 for patients who have received at least four prior therapies.

What factors will you consider when selecting a BCMA-directed therapy for triple-refractory patients? Are there certain groups of patients better suited for either an antibody-drug conjugate or a CAR-T therapy? Do you think anti-BCMA agents will eventually be used in earlier lines of therapy?