US researchers have examined the outcomes of patients who relapsed after chimeric antigen receptor (CAR) T cell therapy for multiple myeloma.
The team believe this analysis will aid future research and help define optimal treatment strategies.
CAR T cell therapy that targets the B-cell maturation antigen (BCMA) protein is highly effective for patients with relapsed multiple myeloma. However, most patients eventually relapse.
A team led jointly by Dr Samir Parekh of Mount Sinai and Dr Sham Mailankody of Memorial Sloan Kettering, New York, set out to review variety and effectiveness of the treatments that patients receive afterwards. They used information on 79 patients with multiple myeloma whose disease progressed after BCMA-directed CAR-T cell therapy. For these patients, a total of 237 courses of various post-CAR T “salvage” treatments were used.
Overall survival from the point of relapse after CAR-T treatment was about 18 months on average. Just under half (43%) of patients responded to their first salvage treatment.
The best responses were seen for therapies that engage T cells, including bispecific antibodies and other types of CAR-T cell therapy.
The researchers write in the journal Blood: “Patients with multiple myeloma who relapse after BCMA-directed CAR T have a limited prognosis but can be potentially treated with multiple lines of salvage therapy.
“T cell-engaging therapies appear to maintain pronounced clinical activity in this setting.”
Dr Samir Parekh commented: “The findings of this study will serve as a benchmark for future prospective clinical studies that intend to improve the outcomes of patients who progress after CAR T.
“This is one of the most urgent and unmet needs in myeloma patients and, therefore, of great interest to the haematology community.”
Van Oekelen O, Nath K, Mouhieddine TH, Farzana T, Aleman A, Melnekoff DT, Ghodke-Puranik Y, Shah GL, Lesokhin AM, Giralt SA, Thibaud S, Rossi A, Rodriguez C, Sanchez L, Richter J, Richard S, Cho HJ, Chari A, Usmani SZ, Jagannath S, Shah UA, Mailankody S, Parekh S. (2022) “Interventions and outcomes of multiple myeloma patients receiving salvage treatment after BCMA-directed CAR T therapy.” Blood, doi: 10.1182/blood.2022017848
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