Table 3.

Comparison of BCMA-targeted modalities in MM

ADCsBispecific antibodies/BiTEsCAR T cells
Off the shelf Yes Yes No* 
Logistics/ease of administration Easiest, outpatient dosing More difficult, requires hospitalization for initial dosing, familiarity with CRS/neurotoxicity management Most difficult, requires leukapheresis, specialty center with CAR T expertise, delays owing to manufacturing, hospitalization, familiarity with CRS/neurotoxicity management 
Repeated dosing required Yes Yes No 
Dependent on patient T-cell “fitness” No Yes Yes 
Unique toxicities Infusion reactions, toxin dependent CRS, neurotoxicity CRS, neurotoxicity 
Toxicity duration Ongoing Ongoing Usually 7-21 d 
Durable clinical activity seen Yes Yes Yes 
ADCsBispecific antibodies/BiTEsCAR T cells
Off the shelf Yes Yes No* 
Logistics/ease of administration Easiest, outpatient dosing More difficult, requires hospitalization for initial dosing, familiarity with CRS/neurotoxicity management Most difficult, requires leukapheresis, specialty center with CAR T expertise, delays owing to manufacturing, hospitalization, familiarity with CRS/neurotoxicity management 
Repeated dosing required Yes Yes No 
Dependent on patient T-cell “fitness” No Yes Yes 
Unique toxicities Infusion reactions, toxin dependent CRS, neurotoxicity CRS, neurotoxicity 
Toxicity duration Ongoing Ongoing Usually 7-21 d 
Durable clinical activity seen Yes Yes Yes 
*

Allogeneic “off-the-shelf” CAR T cells are in development for MM, but no clinical data are available yet.

The anti-BCMA ADC GSK2857916 does require close monitoring with an ophthalmologist owing to corneal toxicity; other non–MMAF-containing ADCs should not have this issue.

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