Real-world experience of patients with multiple myeloma receiving ide-cel after a prior BCMA-targeted therapy

Abstract

Most patients with multiple myeloma experience disease relapse after treatment with a B-cell maturation antigen-targeted therapy (BCMA-TT), and data describing outcomes for patients treated with sequential BCMA-TT are limited. We analyzed clinical outcomes for patients infused with standard-of-care idecabtagene vicleucel, an anti-BCMA chimeric antigen receptor (CAR) T-cell therapy, at 11 US medical centers. A total of 50 patients with prior BCMA-TT exposure (38 antibody-drug conjugate, 7 bispecific, 5 CAR T) and 153 patients with no prior BCMA-TT were infused with ide-cel, with a median follow-up duration of 4.5 and 6.0 months, respectively. Safety outcomes between cohorts were comparable. The prior BCMA-TT cohort had a lower overall response rate (74% versus 88%; p = 0.021), median duration of response (7.4 versus 9.6 months; p = 0.03), and median progression-free survival (3.2 months versus 9.0 months; p = 0.0002) compared to the cohort without prior BCMA-TT. All five patients who received a prior anti-BCMA CAR T responded to ide-cel, and survival outcomes were best for this subgroup. In conclusion, treatment with ide-cel yielded meaningful clinical responses in real-world patients exposed to a prior BCMA-TT, though response rates and durability were suboptimal compared to those not treated with a prior BCMA-TT.

Factors associated with refractoriness or early progression after idecabtagene vicleucel in patients with relapsed/refractory multiple myeloma: U.S. Myeloma Immunotherapy Consortium real world experience

“…In two of the previous studies from this consortium, 13 it was shown that prior BCMA targeted therapy was associated with inferior depth and duration of response. One study also showed that with a shorter duration of exposure to the prior BCMA targeted therapy and a significantly longer time from the last BCMA targeted therapy exposure to leukapheresis as well as ide-cel infusion, patients seemed to achieve better outcomes with ide-cel as a sequential therapy.…”

Real-World Impact of Bridging Therapy on Outcomes of Ide-cel for Myeloma in the U.S. Myeloma Immunotherapy Consortium

“…In our cohort, 8 patients received involved eld radiation therapy, resulting in one achieving VGPR, ve showing SD, and two experiencing PD. The median PFS was 6 months (range, [3][4][5][6][7][8][9][10][11][12][13]. However, due to the small number of patients undergoing this treatment, they were not included in the primary analysis for comparison with the remaining type of BT.…”

Real-world impact of bridging therapy on outcomes of ide-cel for myeloma in the U.S. Myeloma Immunotherapy Consortium

“…Limited by retrospective design and lacking BCMA data, reduced PFS might relate to decreased tumor BCMA expression [10]. Our previous data showed lower PFS post BCMA-targeted therapy [11], and hinted at compromised ide-cel efficacy within six months of such treatment [12].…”