The development of several treatment options over the last 2 decades has led to 
a notable improvement in the survival of patients with multiple myeloma. Despite 
these advances, the disease remains incurable for most patients. Moreover, 
standard combinations of alkylating agents, immunomodulatory drugs, proteasome 
inhibitors, and monoclonal antibodies targeting CD38 and corticoids are 
exhausted relatively fast in a proportion of high-risk patients. Such high-risk 
patients account for over 20% of cases and currently represent a major unmet 
medical need. The challenge of drug resistance requires the development of 
highly active new agents with a radically different mechanism of action. Several 
immunotherapeutic modalities, including antibody-drug conjugates and T-cell 
engagers, appear to be promising choices for patients who develop resistance to 
standard combinations. Chimeric antigen-receptor-modified T cells (CAR-Ts) 
targeting B-cell maturation antigen have demonstrated encouraging efficacy and 
an acceptable safety profile compared with alternative options. Multiple CAR-Ts 
are in early stages of clinical development, but the first phase III trials with 
CAR-Ts are ongoing for two of them. After the recent publication of the results 
of a phase II trial confirming a notable efficacy and acceptable safety profile, 
idecabtagene vicleucel is the first CAR-T to gain regulatory US Food and Drug 
Administration approval to treat refractory multiple myeloma patients who have 
already been exposed to antibodies against CD38, proteasome inhibitors, and 
immunomodulatory agents and who are refractory to the last therapy. Here, we 
will discuss the preclinical and clinical development of idecabtagene vicleucel 
and its future role in the changing treatment landscape of relapsed and 
refractory multiple myeloma.