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DREAMM\u20107 established belamaf plus bortezomib\u2010dexamethasone (BVd) as a new reference point, and DREAMM\u20108 showed benefit for belamaf plus pomalidomide\u2010dexamethasone (BPd), although both regimens achieved comparatively modest MRD\u2010negativity rates (24.7% and pending, respectively) relative to CAR\u2010T and emerging BsAb combinations, and depth of response requires further maturation. MajesTEC\u20103 showed teclistamab plus daratumumab achieved a 36\u2010month PFS rate of 83.4%, compared with 29.7% for daratumumab\u2010based triplets. CARTITUDE\u20104 showed ciltacabtagene autoleucel produced a median PFS not reached, compared with 11.8\u2009months with standard of care in lenalidomide\u2010refractory patients with 1\u20133 prior lines, with MRD\u2010negativity of 60.6%. Sequencing data indicate an asymmetric effect: CAR\u2010T efficacy is substantially compromised by prior BCMA\u2010directed BsAb exposure, whereas BsAbs largely retain meaningful activity after prior BCMA\u2010directed CAR\u2010T.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BCMA\u2010directed therapies are rapidly redefining early R\/R MM treatment. Optimal sequencing, management of class\u2010specific toxicities\u2014including immune effector cell\u2010associated hemophagocytic lymphohistiocytosis\u2010like syndrome (IEC\u2010HS), enterocolitis (IEC\u2010EC), and hematotoxicity (ICAHT), in addition to CRS and ICANS\u2014and inclusion in current guidelines require hematologists to develop competency across ADC, BsAb, and CAR\u2010T platforms. Future directions include advancing BCMA therapies into frontline settings, next\u2010generation and in\u00a0vivo\/allogeneic CAR\u2010T approaches, and exploring novel combination strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ejh.70328","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:45:48Z","timestamp":1791362748000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>BCMA<\/scp>\n                    \u2010Targeted Immunotherapy in Early Relapsed\/Refractory Multiple Myeloma: Mechanisms, Clinical Evidence, and Practical Management"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3987-419X","authenticated-orcid":false,"given":"Massimo","family":"Martino","sequence":"first","affiliation":[{"name":"Hematology and Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato\u2010Oncology and Radiotherapy 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