Abstract
Outcomes of BCMA-Directed Chimeric Antigen Receptor T-Cell (CART) Therapy and Teclistamab in Patients with Relapse-Refractory Multiple Myeloma with Extramedullary Disease: A Real-World Experience of the US Myeloma Innovations Research Collaborative (USMIRC)
Transplantation and cellular therapy, Vol.30(2 Supplement), pp.S384-S385
02/2024
DOI: 10.1016/j.jtct.2023.12.538
Abstract
Extramedullary disease (EMD) is an aggressive presentation of multiple myeloma (MM) and considered as a risk factor for poor response to therapy. In recent years, novel BCMA-directed therapies (BDT), including CAR T-cell therapies and the bispecific antibody, teclistamab (Tec), have shown impressive efficacy in heavily pre-treated relapse/refractory MM (RRMM). However, there is limited real-world data available on efficacy and safety of BDT in treating EMD.
Five US academic institutions contributed data to this retrospective analysis, which included RRMM patients with known history or current EMD who received either commercial CART (ide-cel or cilta-cel) or Tec. Fisher's exact test and Kaplan Meier method were used for statistical analysis.
A total of 110 patients were included in this study. Median follow up time for the entire cohort was 5 (range 0.5-22) months. Table 1 summarizes the baseline demographics, disease characteristics and outcomes of the study population. Both groups were heavily pretreated with a median of 6 (range 4-15) prior lines of therapy. The Tec group had higher rates of Eastern Cooperative Oncology Group (ECOG) performance status ≥2, high-risk cytogenetics and prior BDT exposure. Triple and penta-refractory status was comparable between the two groups. Cytokine release syndrome (CRS) was seen in 60% (≥ grade 3: 0%) of patients treated with Tec vs 72% (≥ grade 3: 4.5%) of patients treated with CART (p=0.21). Immune effector cell-associated neurotoxicity syndrome (ICANS) was noted in 15.5% (≥ grade 3: 4.5%) of patients treated with Tec vs 27.5% (≥ grade 3: 4.5%) of patients treated with CART (p=0.16). Infections ≤8 weeks after Tec initiation or CART infusion were seen in 29% vs 38% of patients treated with Tec vs CART, respectively (p=0.31). The best overall response rate was 47% vs 77% in the Tec vs CART groups (p=0.002), respectively; complete response or better rate was 20% vs 42% (p=0.02), respectively. The estimated median progression-free survival for the Tec cohort was 2 months [95% CI, 1.1-not reached [NA]) compared to 6.5 months (95% CI, 5.1-9.6) (p=0.039) of the CART cohort. The estimated median overall survival was for the Tec group was not reached (95% CI, 3.9-NA) compared to 12.9 months (95% CI, 9.5-NA) for the CART group (p=0.057).
This multicenter study delineates outcomes of RRMM patients with known history or current EMD treated with Tec or BCMA-directed CAR T-cell therapy in a real-world setting. Safety aspects including CRS, ICANS, and infection rates were comparable between the two groups. Grade ≥3 CRS and ICANS were infrequent in both groups. However, responses and survival outcomes were inferior for the Tec group, which could be explained by the more aggressive disease biology observed in this group, as indicated by the worse performance status, and higher rates of high-risk cytogenetics, and prior BDT exposure.
Details
- Title: Subtitle
- Outcomes of BCMA-Directed Chimeric Antigen Receptor T-Cell (CART) Therapy and Teclistamab in Patients with Relapse-Refractory Multiple Myeloma with Extramedullary Disease: A Real-World Experience of the US Myeloma Innovations Research Collaborative (USMIRC)
- Creators
- Danai Dima - Cleveland ClinicJames Davis - Medical University of South CarolinaNausheen Ahmed - University of Kansas Medical CenterAishwarya Sannareddy - The University of Texas Southwestern Medical CenterHira Shaikh - University of IowaLeyla Shune - University of Kansas Medical CenterGurbakhash Kaur - The University of Texas Southwestern Medical CenterJack Khouri - Cleveland ClinicAimaz Afrough - The University of Texas Southwestern Medical CenterChristopher Sun Strouse - University of IowaJonathan Lochner - University of IowaZahra Mahmoudjafari - University of Kansas Medical CenterShahzad Raza - Cleveland ClinicJason Valent - Cleveland ClinicLarry D. Anderson - The University of Texas Southwestern Medical CenterFaiz Anwer - Cleveland ClinicHamza Hashmi - Medical University of South CarolinaAl-Ola Abdallah - US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, KS
- Resource Type
- Abstract
- Publication Details
- Transplantation and cellular therapy, Vol.30(2 Supplement), pp.S384-S385
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jtct.2023.12.538
- ISSN
- 2666-6367
- eISSN
- 2666-6367
- Language
- English
- Date published
- 02/2024
- Academic Unit
- Internal Medicine; Hematology, Oncology, and Blood & Marrow Transplantation
- Record Identifier
- 9984559774602771
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