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April 28, 2022

Chimeric Antigen Receptor T-Cell Therapy in Multiple Myeloma—Challenges and Potential Solutions

Author Affiliations
  • 1Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
JAMA Oncol. 2022;8(6):823-824. doi:10.1001/jamaoncol.2022.0319

The US Food and Drug Administration approved the use of idecabtagene vicleucel (ide-cel) in patients with multiple myeloma (MM) who received at least 4 prior lines of therapy.1 Patients with MM with triple-class (proteasome inhibitor, immunomodulatory drug, and anti-CD38 monoclonal antibody) refractory status have limited effective treatment options; therefore the development of new therapeutic options for these patients is crucial. Clinical benefit of ide-cel was shown in the Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma (KarMMa) study, which reported a progression-free survival of approximately 9 months in 128 patients with MM who received pretreatment.2 Most patients who were treated in the KarMMa study had a good performance status (Eastern Cooperative Oncology Group performance status 1 or 2) and received bridging therapy for a median of 15 days (range, 1 to 33 days).2 Clinicians were required to hold bridging therapy for at least 14 days prior to lymphodepletion that preceded the chimeric antigen receptor (CAR) T-cell therapy product infusion. Patients were monitored in the hospital for a minimum of 14 days after the CAR T-cell infusion for adverse events that occurred in most of the patients at various degrees. The efficacy of ide-cel in patients with MM who received heavy pretreatment and had triple-class exposure was superior with a potential improvement in overall survival compared with a historical cohort who received conventional treatment.3

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