92%. 89%. 68%. Those are the pooled hematologic ORRs for CAR-T, bispecifics and belantamab in relapsed/refractory AL amyloidosis, from the Blood Advances analysis Muzaffar flagged (Alqazaqi, Sanchorawala, Al Hadidi and colleagues). 256 pts pulled from trials, real-world series and case reports: 89 CAR-T, 82 BsAb, 85 ADC. Overall ORR 83%, and ≥VGPR in ~70% of CAR-T and BsAb recipients. 64% had cardiac involvement. 1. Cardiac responses in 41% of evaluable pts (49% with BsAb, 40% with CAR-T). In AL the clone is only half the story. The heart is what kills pts, so this number matters more to me than the ORR 2. Grade ≥3 CRS was 9% with CAR-T and 1% with BsAb. I was more worried about CRS in an amyloid-infiltrated heart than these data suggest we need to be, at least in the pts who made it to treatment 3. Belantamab works, but 84% any-grade ocular toxicity (29% grade ≥3) makes it a harder drug to live with 4. Grade ≥3 infections 13% with CAR-T, 20% with BsAb. Lower than I'd have guessed, which probably says more about short follow-up than safety Challenges of any such presentation 1. Published cases only capture pts fit enough to be referred, collected and infused, and cardiac staging wasn't uniformly reported. The sickest cardiac pts are definately underrepresented 2. Durability. Follow-up ranged from 1.6 to 19 months. Too short to know if a BCMA-driven CR in AL holds the way dara-based responses do 3. Duration. AL clones are usually small. Do we really need continuous bispecific dosing, or can we stop at hematologic CR and spare the infections? The authors are upfront that this is descriptive, with no formal meta-analytic pooling, mixing case reports with phase 1 data. Case reports skew positive. So the gap here is translational: a strong signal, and no prospective comparator to anchor it yet. Practically, for a dara-refractory pt with cardiac AL and few options left, this supports an early referal to a center that can deliver BCMA-directed Tx ! Congratulations to the team. @HadidiSamer @vsanchorawala @ldandersonjr #Amyloidosis #mmsm #CARTcell