Table 3.

Comparison of BCMA-directed immunotherapies for patients with advanced MM (mostly triple-class refractory MM).

		Autologous CAR T-cell therapy(10,11,23,82)	Bispecific antibodies(140–145)	Antibody-drug conjugates(146–148)
Efficacy	≥PR	70–97%	60–80% at higher dose levels	Around 30%
	≥CR	30–67%	Around 20% at higher dose levels Depth of response may still improve given the relatively short follow-up	Around 3%
Safety	CRS	65–95% (grade ≥3: 3–5%)	39–77% (grade ≥3 in 0–9%) CRS is generally confined to step-up and first full doses	Not observed
	Neurotoxicity	13–21% (grade ≥3: 3–10%)	0–20% (grade ≥3: 0–1%)	Not observed
	Ocular toxicity	Not observed	Not observed	Ocular toxicity/keratopathy common Belantamab mafodotin 2.5 mg/kg: grade ≥3 keratopathy: 27% [any grade: 71%]
Practical considerations	Availability	Currently only available in clinical trials	Currently only available in clinical trials	Belantamab mafodotin is approved
	Number of administrations	Generally a single infusion, followed by drug holiday	Treatment until progression	Treatment until progression
	Hospitalization	Inpatient treatment	Hospitalization often required during step-up and first full doses	Fully outpatient
	Route of administration	IV	IV or SC	IV
	Infrastructure	Requires dedicated facilities (e.g. cell therapy unit), and input from dedicated infectious disease specialists, intensive care physicians, and neurologists	Can be offered in most hospitals, but intensive care unit should be present for management of severe CRS	Baseline and follow-up assessments by ophthalmologist are required to manage ocular toxicity
	Off-the-shelf available	No (but allogeneic CAR T-cells are off-the-shelf available) May complicate treatment of patients with aggressive/rapidly progressive disease	Yes	Yes
Other features		Gene editing will contribute to next-generation CAR T-cell products with enhanced killing capacity and improved persistence Several other targets explored	Several other targets explored Trispecific antibodies and bi/trispecific NK cell engagers in (pre)clinical development	Several other targets explored Other types of immunoconjugates are in clinical development, such as immunocytokines and immunotoxins