Targeted immunotherapy has emerged as a promising approach for treating multiple myeloma (MM), a progressive hematological malignancy characterized by immune system dysfunction. This review discusses various immunotherapeutic strategies, including monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, and checkpoint inhibitors, which have shown significant clinical potential. Exosome-based bispecific monoclonal antibodies are highlighted as a novel cell-free immunotherapy option. Current immunotherapies for MM include CAR-T cells, CAR-NK cells, checkpoint inhibitors, and monoclonal antibodies, which have demonstrated efficacy in improving survival and remission rates in relapsed/refractory MM (R/RMM) patients. However, challenges such as toxicity, treatment resistance, and the need for personalized approaches remain. CAR-T cell therapy targeting BCMA has shown promising results, with some regimens achieving high response rates and prolonged progression-free survival. CAR-NK cells offer a safer alternative due to their reduced inflammatory effects. Checkpoint inhibitors, such as PD-1/PD-L1 inhibitors, have shown limited efficacy in R/RMM but may be combined with other therapies to enhance outcomes. Monoclonal antibodies like daratumumab and isatuximab have been FDA-approved for MM treatment, with daratumumab demonstrating significant improvements in remission rates and survival. Elotuzumab, targeting SLAMF7, has also shown efficacy when combined with other agents. Antibody-drug conjugates, such as belantamab mafodotin, have demonstrated good safety profiles and efficacy in R/RMM. Bispecific antibodies, including those targeting BCMA and CD3, have shown promise in clinical trials, with some achieving high response rates and manageable toxicity. Despite these advancements, further research is needed to optimize these therapies, address resistance, and improve patient outcomes. The development of novel targets and combination therapies remains a key focus in the treatment of MM.Targeted immunotherapy has emerged as a promising approach for treating multiple myeloma (MM), a progressive hematological malignancy characterized by immune system dysfunction. This review discusses various immunotherapeutic strategies, including monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, and checkpoint inhibitors, which have shown significant clinical potential. Exosome-based bispecific monoclonal antibodies are highlighted as a novel cell-free immunotherapy option. Current immunotherapies for MM include CAR-T cells, CAR-NK cells, checkpoint inhibitors, and monoclonal antibodies, which have demonstrated efficacy in improving survival and remission rates in relapsed/refractory MM (R/RMM) patients. However, challenges such as toxicity, treatment resistance, and the need for personalized approaches remain. CAR-T cell therapy targeting BCMA has shown promising results, with some regimens achieving high response rates and prolonged progression-free survival. CAR-NK cells offer a safer alternative due to their reduced inflammatory effects. Checkpoint inhibitors, such as PD-1/PD-L1 inhibitors, have shown limited efficacy in R/RMM but may be combined with other therapies to enhance outcomes. Monoclonal antibodies like daratumumab and isatuximab have been FDA-approved for MM treatment, with daratumumab demonstrating significant improvements in remission rates and survival. Elotuzumab, targeting SLAMF7, has also shown efficacy when combined with other agents. Antibody-drug conjugates, such as belantamab mafodotin, have demonstrated good safety profiles and efficacy in R/RMM. Bispecific antibodies, including those targeting BCMA and CD3, have shown promise in clinical trials, with some achieving high response rates and manageable toxicity. Despite these advancements, further research is needed to optimize these therapies, address resistance, and improve patient outcomes. The development of novel targets and combination therapies remains a key focus in the treatment of MM.