The treatment of multiple myeloma has changed dramatically in recent years, with huge strides forward made in the field. Chimeric antigen receptor T-cell therapy targeting the B cell maturation antigen (BCMA) is now widely approved in relapsed refractory patients and is moving into earlier treatment lines. In this review, we discuss the evidence underpinning current regulatory approvals and consider mechanisms through which CAR-T cell efficacy could be improved. These include tackling BCMA-loss, harnessing the immunosuppressive tumour microenvironment, manufacturing concerns including the potential role of other cellular sources, safety issues such as cytokine release syndrome and neurotoxicity, and optimal patient selection.

近年来，多发性骨髓瘤的治疗发生了巨大变化，在该领域取得了巨大进步。靶向 B 细胞成熟抗原 （BCMA） 的嵌合抗原受体 T 细胞疗法现已广泛批准用于复发难治性患者，并正在进入早期治疗线。在这篇综述中，我们讨论了支持当前监管批准的证据，并考虑了可以提高 CAR-T 细胞疗效的机制。这些包括解决 BCMA 丢失、利用免疫抑制性肿瘤微环境、制造问题（包括其他细胞来源的潜在作用）、安全问题（如细胞因子释放综合征和神经毒性）以及最佳患者选择。