Dr Garfall on the Rationale of the Phase 2 BMT CTN 1902 Trial in Myeloma

“We see this trial as a logical progression of prior ideas looking for ways to integrate therapies that have been effective in relapsed myeloma into first-line therapy.”

Alfred L. Garfall, MD, MS, associate professor of medicine (hematology-oncology) and director, Autologous Hematopoietic Cell Transplantation, Cell Therapy and Transplant Program, Hospital of the University of Pennsylvania; and section chief, Multiple Myeloma, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, discusses the rationale of the phase 2 BMT CTN 1902 trial (NCT05032820).

BMT CTN 1902 examined idecabtagene vicleucel (ide-cel; Abecma) followed by lenalidomide (Revlimid) maintenance in patients with multiple myeloma who had a suboptimal response following frontline autologous hematopoietic cell transplant (auto-HCT). The single-arm study enrolled adult patients who experienced less than a complete response (CR) following auto-HCT and 3 months of lenalidomide-based maintenance therapy. Eligible patients also needed to have symptomatic disease and no prior disease progression at approximately 6 months post-transplant.

The primary end point was 6-month CR rate. Secondary end points included overall responses and upgrade of responses, minimal residual disease (MRD) status in the first 6 months, disease progression, initiation of lenalidomide, cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), infections, and CAR T-cell in vivo expansion.

Investigators are interested in integrating therapies that have shown prior efficacy in the relapsed/refractory setting, such as ide-cel, into earlier lines of treatment, Garfall notes. BMT CTN 1902 is one of multiple studies evaluating CAR T-cell therapy in the post-transplant setting, he adds.

Findings presented during the 2025 Transplantation & Cellular Therapy Meetings showed that efficacy-evaluable patients (n = 38) converted to a CR by 6 months at a rate of 63%; an additional 24% experienced an upgraded response other than a CR. The MRD-negativity rate at 6 months was 87% and 95% of patients achieved MRD negativity at any time point.

In terms of safety, 81.6% of patients experienced any-grade CRS, comprised of grade 1 and 2 events occurring at respective rates of 68.4% and 13.2%. The median time to CRS onset was 1 day (range, 0-4) and the median time to CRS resolution was 2.5 days (range, 0-6). Notably, no instances of ICANS were reported.