**9.3 Monoclonal antibodies (CAR T cells and BCMA)**

Monoclonal antibodies represent an emerging class of agents in MM treatment [72]. Daratumumab-RVd versus RVd, are being evaluated for ASCT-eligible patients [27]. Isatuximab, a humanized immunoglobulin G1 monoclonal antibody, has distinct characteristics in contrast to other anti-CD38 monoclonal antibodies [72]. Isatuximab in combination with IMROZ, isatuximab-RVd in ASCT-ineligible patients with newly diagnosed MM are being studied [72]; and isatuximab-Kd (IKEMA) and isatuximab-Pd (ICARIA) have been tried in patients with relapsed or refractory MM [73].

B-cell maturation antigen (BCMA) is a significant target communicated on MM cells, with other targets counting GPR5CD, CD138, CD74, CD48, CD38, SLAMF7, and transmembrane activator and calcium modulator and cyclophilin ligand (CAML) interactor (TACI). Several strategies targeting BCMA include conjugated antibodies, cellular approaches, and bispecific T-cell engagers. Clinical trials evaluating BCMA-directed Chimeric antigen receptor redirected T cells (CAR-T cells) are furthest in development. Two notable BCMA CAR T-cell products are bb2121 and LCAR-B38M.69–71 Trials are evaluating CAR T cells in patients with relapsed or refractory MM to better understand their role in the MM treatment paradigm [74, 75].

Newly introduced therapies that uses CAR T cells and BCMA antibodies bid promises of adding agents to the antimyeloma armamentarium of neoadjuvant mechanisms of actions [49]. Enduring trials will permit for the integration of

therapies with novel mechanisms of action, with the goal of inducing deeper responses as we endeavor towards the prospect of curative aspect of MM [27].
