Sham Mailankody, MBBS, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses research regarding the BCMA CAR T-cell therapy bb2121 in patients with relapsed/refractory multiple myeloma.

There are many studies examining BCMA CAR T-cell therapy in various stages of clinical development. A recent publication in the 

 showed that bb2121, a BCMA CAR T-cell product that was used for treatment of patients with relapsed/refractory multiple myeloma, is associated with high response rates, explains Mailankody.

The overall response rate was 85% and the complete response rate was 45%, which is unprecedented in this patient population. However, relapses are common and, in this study, the median progression-free survival was 11.7 months, showing that there is room for improvement, Mailankody concludes.

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Sham Mailankody, MBBS, discusses research regarding the BCMA CAR T-cell therapy bb2121 in patients with relapsed/refractory multiple myeloma.

Dr. Mailankody on BCMA CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma

Sham Mailankody, MBBS, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses minimal residual disease (MRD) negativity in multiple myeloma.

Studies show that achieving MRD negativity is associated with better progression-free survival and overall survival; however, it is unclear whether treatment decisions should be driven by MRD-negative status, explains Mailankody. This question is being actively investigated at the Memorial Sloan Kettering Cancer Center where investigators are testing the MRD status of patients at different time points, including at the end of induction, the end of transplant, and when doing follow-up at maintenance. MRD is tested using flow cytometry and next-generation sequencing, which Mailankody believes provides valuable prognostic information.

These tests are used on a case-by-case basis to determine whether treatments need to be tailored. For example, for patients who achieve MRD-negative status after induction, patients are given the option of collecting their stem cells and deferring consolidated autologous transplant to the time of relapse, says Mailankody. Although this practice is not yet established based on large randomized studies, emerging evidence suggests that this is a reasonable strategy for a select group of patients with newly diagnosed multiple myeloma, adds Mailankody.

A remaining question has to do with whether an MRD-negative patient who is on maintenance for an extended period of time can come off of maintenance therapy safely, or if they need to remain on that therapy indefinitely. Clinical trials are needed to explore this question further and those trials are either being designed or are ongoing, concludes Mailankody.

Sham Mailankody, MBBS, discusses minimal residual disease negativity in multiple myeloma.

Dr. Mailankody on MRD-Negative Status in Multiple Myeloma

Sham Mailankody, MBBS, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses results of the CASSIOPEIA trial in patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant.

The most recent standard of care for multiple myeloma has been triplet combinations, the most common one in the United States being lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (VRd), explains Mailankody. Another common triplet regimen is thalidomide (Thalomid), bortezomib, and dexamethasone (VTd), which is more common in Europe, says Mailankody.

The CASSIOPEIA trial examines adding daratumumab (Darzalex) to the VTd combination to create a quadruplet therapy. The reasoning behind adding daratumumab, according to Mailankody, is that adding a fourth drug could improve responses, similar to how 3 drugs was better than 2 drugs when evaluating triplet regimens. The CASSIOPEIA study showed an improvement in response rate and progression-free survival, leading to 

FDA approval for daratumumab plus VTd quadruplet in September 2019

. Further research must be done to see how the addition of daratumumab affects other 3-drug regimens, including VRd and carfilzomib (Kyprolis)/lenalidomide/dexamethasone, concludes Mailankody.

Sham Mailankody, MBBS, discusses results of the CASSIOPEIA trial in patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant.

Sham Mailankody, MBBS

Articles

Dr. Mailankody on BCMA CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma

Dr. Mailankody on MRD-Negative Status in Multiple Myeloma

Dr. Mailankody on CASSIOPEIA Results in Newly Diagnosed Multiple Myeloma