Timing of Toxicities and Non-Relapse Mortality Following CAR T Therapy in Myeloma.

Autor: Wesson W; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas. Electronic address: wwesson@kumc.edu., Dima D; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas; Cleveland Clinic Foundation, Cleveland, Ohio., Suleman N; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas., Saif MSI; Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas., Tabak C; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas., Logan E; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas., Davis JA; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas; Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina., McGann M; Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina., Furqan F; Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Mohan M; Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Rashid A; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas., Abdallah AO; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas., Ullah F; Cleveland Clinic Foundation, Cleveland, Ohio., Shune L; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas., Mushtaq MU; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas., Raza S; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas; Cleveland Clinic Foundation, Cleveland, Ohio., McGuirk J; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas., Hamadani M; Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Anwer F; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas; Cleveland Clinic Foundation, Cleveland, Ohio., Hashmi H; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas; Department of Medicine, Multiple Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York., Ahmed N; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Westwood, Kansas; U.S. Myeloma Innovations Research Collaborative, Kansas City, Kansas.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2024 Sep; Vol. 30 (9), pp. 876-884. Date of Electronic Publication: 2024 Jun 11.
DOI: 10.1016/j.jtct.2024.06.012
Abstrakt: BCMA-directed chimeric antigen receptor T-cell (CAR T) therapies, including idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), have transformed the treatment landscape for relapsed-refractory multiple myeloma (RRMM), offering remarkable efficacy with hallmark toxicity risks of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The FDA mandates a 4-week monitoring period at the treatment center as part of a Risk Evaluation and Mitigation Strategy (REMS) to monitor and manage these toxicities, which, while prudent, may add unnecessary challenges related to access and socioeconomic disparities. We sought to assess CRS and ICANS onset and duration, as well as causes of non-relapse mortality (NRM) in real-world BCMA CAR T recipients in order to better inform future changes to the monitoring guidelines for CAR T recipients. This is a retrospective study across four academic centers that examined 129 ide-cel and cilta-cel recipients that received CAR T cell infusions from May 2021 to June 2023. Infusion and toxicities were managed per institutional guidelines in accordance with previously published guidelines. While differences were noted in the incidence and duration of CRS/ ICANS between ide-cel and cilta-cel, late-onset CRS and ICANS were rare after 2 weeks following infusion (0% and 1.6%, respectively). NRM was driven by hemophagocytic lymphohistiocytosis and infections in the early follow-up period (1.1% until Day 29), then by infections through three months post-infusion (1.2%). Our findings suggest that 25% of patients had to relocate for 4 weeks due to distance from the treatment center. With the low risk of CRS and ICANS after 2 weeks, a flexible shorter monitoring period may be reasonable, emphasizing collaboration with referring oncologists to improve NRM.
(Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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