The treatment landscape of multiple myeloma (MM) has evolved substantially, but it remains largely incurable so new treatment options are required. Antibody drug conjugates (ADCs) are an emerging therapeutic class used in Cancer to deliver targeted therapy. ADCs are composed of three components, an antibody, a chemical linker and a payload which must be chosen carefully to be effective and safe. This alternative mechanism of action to standard treatments makes ADCs an attractive class for further development. However, several ADCs have been investigated but many have not moved further than phase 1 trials, highlighting the challenges in designing an effective and tolerable ADC. Belantamab Mafodotin is currently the only ADC licensed for MM although others are currently under evaluation. Belantamab Mafodotin demonstrated efficacy as monotherapy in triple class exposed patients and combinations are under development which maintain safety with encouraging efficacy particularly at earlier lines of therapy. Retaining an acceptable adverse event profile for ADCs remains vital for their success. Strategies to mitigate ocular events for Belantamab Mafodotin involve lower and less frequent dosing as well as the use of gamma secretase inhibitors. The optimal sequencing of ADCs within the treatment pathway including novel immunotherapies is now under evaluation. 1 | INTRODUCTION Multiple myeloma (MM) is the second most common hematological malignancy in the United States, accounting for 1.8% of all new cancer cases. 1 It is characterized by uncontrolled proliferation of clonal plasma cells, resulting in skeletal lytic lesions, renal impairment, hypercalcemia, and bone marrow failure. The treatment landscape for MM has changed significantly in recent years with new treatment approvals corresponding to improvements in overall survival. Advances in understanding various surface antigens on plasma cells have led to the development of new classes of treatment for MM. These represent a shift to more precise and targeted medicine.Anti-CD38 monoclonal antibodies (mAb) are now routinely incorporated into standard treatments and more recently an antibody drug conjugate (ADC) and two chimeric antigen receptor T cell (CAR-T) therapies have been approved for relapsed refractory MM (RRMM). 2,3 There is also emerging data for bispecific T cell engagers. This review focuses on the development of antibody drug conjugates (ADCs) for MM. ADCs are an emerging class of treatment in hematological malignancies with a number in routine clinical use. Examples include inotuzumab ozogamicin (anti-CD22) for acute lymphoblastic leukemia (ALL), gemtuzumab ozogamicin (anti-CD33) for acute myeloid leukemia (AML), brentuximab vedotin (anti-CD30) for Hodgkin lymphoma and polatuzumab vedotin (anti-CD79a) in combination with bendamustine and rituximab for relapsed diffuse large B cell lymphoma (DLBCL). In MM, one ADC has been approved, Belantamab Mafodotin (anti-B Cell Maturation Antigen [BCMA]).ADCs are highly selective humanized or human mAbs chemically l...

Background: Background:Venetoclax (Ven) in combination with hypomethylating agents, such as azacitidine (Aza) and low dose cytarabine (LDAC) has been shown to be effective therapy in acute myeloid leukaemia (AML) and has become standard of care for newly-diagnosed patients unfit for intensive chemotherapy (