Dr Garfall on the Potential Role for Consolidation or Maintenance CAR T-Cell Therapy in Myeloma

"Data [from the phase 2 BMT CTN 1902 trial (NCT05032820)] support those ongoing randomized efforts [looking at other potential roles for CAR T-cell therapy] and could be supportive of future randomized comparative studies to look specifically in the post-transplant setting."

Alfred Garfall, MD, associate professor of medicine (hematology-oncology) and director of Autologous Hematopoietic Cell Transplantation in the Cell Therapy and Transplant Program at the Hospital of the University of Pennsylvania; and section chief of Multiple Myeloma in the Division of Hematology/Oncology in the Department of Medicine of Perelman School of Medicine at the University of Pennsylvania, discusses the potential role of CAR T-cell therapy in the consolidation or maintenance setting for patients with multiple myeloma.

Garfall notes that multiple recent studies have explored CAR T-cell therapy in consolidation or maintenance settings, demonstrating clinical activity and an acceptable safety profile in these areas.

One study, the phase 2 BMT CTN 1902 trial (NCT05032820), evaluated idecabtagene vicleucel (ide-cel; Abecma) followed by lanalidomdie (Revlimid) maintenance in patients who had a suboptimal response following to up-front autologous stem cell transplant (ASCT), and data showed that this regimen led to high rates of complete response and minimal residual disease negativity. Additionally, other studies are looking at CAR T-cell therapy without ASCT, such as the ongoing phase 3 CARTITUDE-6 trial (NCT05257083), which is a randomized study comparing ASCT vs ciltacabtagene autoleucel (cilta-cel; Carvykti) as consolidation following induction therapy with daratumumab (Darzalex), bortezomib (Velcade), lenalidomide, and dexamethasone.

Notably, another phase 3 randomized trial evaluating ide-cel as post-transplant consolidation was initiated but was halted due to low global accrual, despite significant patient interest in this approach, Garfall says.

Ongoing research could help continue to define the potential role of CAR T-cell therapy in the early treatment landscape for multiple myeloma, particularly in patients with low disease burden following ASCT, Garfall explains. Further randomized comparative studies will be essential in defining the optimal sequencing and integration of CAR T-cell therapy into standard treatment algorithms, Garfall concludes.