B-cell maturation antigen (BCMA) has become a key target for antibody-drug conjugates, bispecific antibodies, chimeric antigen receptor T-cell therapies, and other immunotherapies in multiple myeloma. Some of these agents such as belantamab mafodotin and idecabtagene vicleucel have already received regulatory approval in the United States. Although BCMA has generally been considered to be expressed almost exclusively in plasma cells with a low likelihood of on-target off-tumor toxicity, there has been a range of unusual neurotoxicity observed across the spectrum of BCMA immunotherapies. In certain cases, these unusual neurotoxicity presentations have led to patient death or withdrawal of agents from further development. Our review summarizes the literature in this field and highlights the possibility of on-target toxicities due to neural expression of BCMA. We draw attention to the need for further investigation of these toxicities. This risk becomes increasingly important as BCMA targeted therapies are brought to earlier lines of treatment.

B 细胞成熟抗原 (BCMA) 已成为抗体药物偶联物、双特异性抗体、嵌合抗原受体 T 细胞疗法和其他多发性骨髓瘤免疫疗法的关键目标。其中一些药物如 belantamab mafodotin 和 idecabtagene viceucel 已在美国获得监管部门的批准。尽管人们普遍认为 BCMA 几乎只在浆细胞中表达，而且在靶外肿瘤毒性的可能性很小，但在 BCMA 免疫疗法的范围内观察到了一系列不寻常的神经毒性。在某些情况下，这些不寻常的神经毒性表现导致患者死亡或停止进一步开发药物。我们的综述总结了该领域的文献，并强调了由于 BCMA 的神经表达导致的靶向毒性。我们提请注意对这些毒性进行进一步调查的必要性。随着 BCMA 靶向治疗被引入早期治疗线，这种风险变得越来越重要。