Dr. Brunner on the Use of CAR T-cell Therapy to Improve Post-ASCT Responses in Multiple Myeloma

Matthew Brunner, MD, assistant professor, hematologic specialist, medical oncology, and palliative care, Department of Medicine, University of Wisconsin Carbone Cancer Center, discusses how the phase 2 BMT CTN 1902 trial (NCT05032820) of anti-BCMA CAR T-cell therapy will attempt to address an area of unmet need in multiple myeloma.

In the field of multiple myeloma, there is significant interest in investigating novel strategies for the management of patients who do not respond to initial therapy, Brunner begins. Previous research has shown that the use of maintenance therapy in patients who respond to first-line induction therapy and autologous stem cell transplant (ASCT) can sustain remission for several years, Brunner states. However, patients who do not achieve remission with this approach lack sufficient alternatives, Brunner says.

The multicenter, single-arm, BMT CTN 1902 trial was designed to address this unmet need by evaluating the use of consolidative CAR T-cell therapy in patients who achieve very good partial responses or worse within 12 months of standard ASCT and lenalidomide (Revlimid) maintenance therapy, Brunner introduces. Patients included in the study are between 18 and 71 years of age and should have not experienced disease progression after initial systemic therapy was administered. 

As this population has not been previously treated with an intensive approach, investigators hope to achieve deeper, more durable responses after up-front ASCT with more robust lymphocytes, Brunner explains.

The trial’s primary objective is to determine the efficacy of BCMA-directed CAR T-cell therapy in this population, Brunner states. 

Additionally, there are long-term toxicities associated with CAR T-cell therapy that can affect a patient’s response to treatment, Brunner adds. Therefore, the trial will also assess the frequency and severity of treatment-related adverse effects, including cytokine release syndrome, immune cytopenias, and neurotoxicity, Brunner concludes. The trial is currently open to enrollment.