Source: Myeloma – Hematology Advisor
A novel prognostic model may aid in the timing of chimeric antigen receptor (CAR) T-cell therapy among patients with relapsed or refractory multiple myeloma (MM), according to research published in the Journal of Clinical Oncology.
Many patients with relapsed or refractory MM have benefited from the introduction of CAR-T therapies, which have induced complete remissions successfully in this difficult-to-treat population. Early relapse to CAR-T cell therapy, however, remains a significant concern, and is linked with a heightened risk of mortality.
This risk necessitates a model that effectively predicts early relapse, which may help to optimize timing of CAR-T therapy. For this retrospective study, researchers evaluated characteristics and outcomes among patients with relapsed or refractory MM who received a B-cell maturation antigen-targeting CAR-T therapy to create a novel model for predicting early relapse.
Data from 269 patients were included and divided into 2 cohorts: a European cohort (136 patients) and a United States cohort (133 patients). Patients received academic CAR-T cells (60 patients), idecabtagene ciloleucel (171 patients), or ciltacabtagene autoleucel (38 patients).
Analysis of outcomes in the 2 cohorts showed an overall response rate of 87% in both. The complete response rate in the European cohort was 48% compared with 49% in the United States. Moreover, the median time to relapse was 5 months.
Further analysis showed that early relapse (defined as less than 5 months from infusion) was linked with a 12-month overall rate of 30% in Europe and 14% in the United States.
The researchers used 4 independent predictive factors to form their model, the Myeloma CAR-T Relapse (MyCARe) model: the presence of extramedullary disease/plasma cell leukemia, disease refractory to lenalidomide, high-risk cytogenetics, and increased ferritin at lymphodepletion. These formed the 4-point, 3-tiered MyCARe mode.
Evaluation of MyCARe showed that the model effectively predicted 5-month incidence of relapse or progression: 7% risk among patients with low-risk disease, 27% for intermediate risk, and 53% for high risk (P <.001). Validation of the model on the US cohort maintained MyCARe’s prognostic utility.
“In summary, we provide the first Euro-American cartography of the efficacy and safety profile of current CAR-T, showing comparable results,” the authors wrote in their report. “We also built the MyCARe model, which can predict early relapse, response, and survival and may facilitate patient selection in this very challenging setting.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.