Targeting B-cell maturation antigen in relapsed or refractory multiple myeloma: On the verge of its prime time

Significant advances have been made in the treatment of multiple myeloma, with B-cell maturation antigen (BCMA)-targeting immunotherapies at the forefront of these developments. Three treatment modalities-including antibody-drug conjugates, bispecific antibodies, and chimeric antigen receptor-T cell therapies-have demonstrated durable responses, each associated with class-specific unique adverse events. Moreover, their efficacy and safety in later stages of multiple myeloma also provide the rationale for their use in earlier lines of therapy. In this review, we briefly outline the background biology of BCMA and discuss the mechanisms of action and structural features of these 3 agents, together with the most recent clinical data from early-phase trials. We also describe class-specific adverse events and mechanisms of resistance, as well as strategies to overcome them, thereby offering a framework to catch up with future developments in BCMA-targeted immunotherapy for multiple myeloma.