Dr Mewawalla on Unmet Needs After Early CAR T-Cell Therapy in Relapsed/Refractory Myeloma

“Our current salvage options and sequencing after using early CAR T-cell therapy are not clearly defined. Do we go to bispecific [antibodies] later? Do we go to our traditional regimens after? This truly needs to be defined after early CAR T-cell therapy.”

Prerna Mewawalla, MD, medical director of Apheresis and a hematologist-oncologist in the Division of Hematology and Cellular Therapy at Allegheny Health Network, as well as an associate professor at the Drexel University College of Medicine, discussed unmet needs and questions that emerge following earlier lines of CAR T-cell therapy for the treatment of patients with relapsed/refractory multiple myeloma.

Notably, in April 2024, the FDA approved ciltacabtagene-autoleucel (Carvykti) for the treatment of patients with relapsed/refractory multiple myeloma who have previously received at least 1 line of therapy—including a proteasome inhibitor (PI) and an immunomodulatory agent (IMiD)—and who are refractory to lenalidomide (Revlimid). At the same time, the FDA also approved idecabtagene vicleucel (Abecma) for the treatment of patients with relapsed/refractory multiple myeloma who have been treated with at least 2 prior lines of therapies, including a PI, an IMiD, and an anti-CD38 monoclonal antibody.

There are several questions that have yet to be addressed regarding further disease management after earlier lines of CAR T-cell therapy in patients with relapsed/refractory multiple myeloma, Mewawalla began. She noted that current salvage options and sequencing strategies after early CAR T-cell therapy are still undefined. Questions include whether bispecific antibodies and traditional regimens should be used following early CAR T-cell therapy, she added.

Furthermore, trials are evaluating whether maintenance therapy is required after CAR T-cell therapies, and whether this could affect patients’ chances of achieving durable responses is another currently unanswered question, Mewawalla stated. The scaling up of CAR T-cell therapy access to meet the growing demand is another unmet need, she explained. CAR T-cell therapies are intensive treatments, and infusion center infrastructure may further limit how many patients can receive these treatments, revealing another disparity, particularly for patients who are eligible but live far away from academic centers or transplant sites, she concluded.