Real-life experiences with CAR T-cell therapy with idecabtagene vicleucel (ide-cel) for triple-class exposed relapsed/refractory multiple myeloma patients.

Autor: Sanoyan DA; Department of Medical Oncology, Inselspital, University Hospital of Bern, Center for Hemato-Oncology; University Cancer Center, Bern, 3010, Switzerland.; Department for Biomedical Research, University of Bern, Bern, 3008, Switzerland., Seipel K; Department for Biomedical Research, University of Bern, Bern, 3008, Switzerland., Bacher U; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Kronig MN; Department of Medical Oncology, Inselspital, University Hospital of Bern, Center for Hemato-Oncology; University Cancer Center, Bern, 3010, Switzerland., Porret N; Clinical Genomics Lab, Inselspital, University Hospital of Bern, Bern, 3010, Switzerland., Wiedemann G; Clinical Genomics Lab, Inselspital, University Hospital of Bern, Bern, 3010, Switzerland., Daskalakis M; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Pabst T; Department of Medical Oncology, Inselspital, University Hospital of Bern, Center for Hemato-Oncology; University Cancer Center, Bern, 3010, Switzerland. Thomas.pabst@insel.ch.
Jazyk: angličtina
Zdroj: BMC cancer [BMC Cancer] 2023 Apr 15; Vol. 23 (1), pp. 345. Date of Electronic Publication: 2023 Apr 15.
DOI: 10.1186/s12885-023-10824-3
Abstrakt: Background: Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment landscape of relapsed/refractory multiple myeloma (RRMM), leading to unprecedented responses in this patient population. Idecabtagene vicleucel (ide-cel) has been recently approved for treatment of triple-class exposed RRMM. We report real-life experiences with the commercial use of ide-cel in RRMM patients.
Methods: We performed a retrospective analysis of the first 16 triple-class exposed RRMM patients treated with ide-cel at a single academic center. We assessed toxicities, response to treatment, CAR T expansion and soluble BCMA (sBCMA) levels.
Results: We identified 16 consecutive RRMM patients treated with ide-cel between 06-10/2022. Median age was 69 years, 6 (38%) patients had high-risk cytogenetics, 3 (19%) R-ISS stage III, and 5 (31%) extramedullary disease. Median number of previous treatment lines was 6 (3-12). Manufacturing success rate was 88% (6% required second lymphapheresis, 6% received an out-of-specification product). At 3 months, the overall response rate (ORR) was 69% (44% sCR, 6% CR, 19% VGPR). Cytokine release syndrome (CRS) occurred in 15 (94%) patients (88% G1, 6% G2), immune effector-cell associated neurotoxicity syndrome (ICANS) in 1 (6% G1), febrile neutropenia in 11 (69%), and infections in 5 (31%). Prolonged hematologic toxicity occurred in 4/16 (25%) patients. Other non-hematological toxicities were elevated hepatic enzymes (38%), colitis (6%, G3) and DIC (6%, G2). Responses were more frequent in patients with higher CAR T expansion (100% vs 38%), and lack of decrease or plateau of sBCMA levels was typically observed in non-responders.
Conclusions: We report one of the first cohorts of RRMM treated with commercial ide-cel. The ORR was 69% and safety profile was manageable, but prolonged hematologic toxicity still represents a major challenge. Responses correlated with in vivo CAR T cell expansion, underlining the need of further research to optimize CAR T expansion.
(© 2023. The Author(s).)
Databáze: MEDLINE
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