This is a case of a 74 yr old man with a history of IgGkappa MM from 2009.He had undergone treatment with Bortezomib-Dexamethasone at diagnosis, which was repeated 6 years afterwards followed by ASCT and Lenalidomide maintenance.Belamaf is a first-in-class humanized IgG1 ADC targeting B-cell maturation antigen (BCMA), covalently linked via a cysteine linker to the microtubule inhibitor monomethyl auristatin F (MMAF), which is released after internalization of the ADC to BCMA on tumor plasma cell, and inhibits its polymerization with the arrest of G2/M caspase dependent apoptosis.The patient received Levofloxacin 12-wk prophylaxis, acyclovir and co-trimoxazole prophylaxis, hydromellose eye drops throughout the treatment period, a coolant eye mask during every Belamaf infusion, and was ophthalmologicaly assessed before each cycle.2 Wk later, patient was urgently re-admitted with consciousness disturbances, weight gain, abdominal pain, defecation incapacity, and significant hyperbilirubinemia (total bilirubin: 6 mg/dL, direct bilirubin: 3 mg/dL, indirect bilirubin: 3 mg/dL).Our patient had never received an Allo-SCT, he had undergone an Autologous SCT many years before the VOD presentation and he had received several lines of treatment without presenting signs of hepatic toxicity.In conclusion, we described a rare case of VOD, histol. proven, in a MM patient on Belamaf-a novel ADC approved for treatment of relapsed or refractory MM.