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Progress and Promise: Advancing Treatment in Relapsed/Refractory Multiple Myeloma - Episode 1

Examining CAR T Eligibility in Clinical Practice in R/R MM

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Panelists discuss how approximately 75% to 80% of patients with multiple myeloma are eligible for chimeric antigen receptor (CAR) T-cell therapy at some point during their care, with eligibility determined by safety criteria including organ function and comorbidities, logistical feasibility, and efficacy considerations rather than direct comparisons to autologous transplant.

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    Peter Voorhees, MD,estimates that 75% to 80% of patients with multiple myeloma are eligible for CAR T-cell therapy at some point during their treatment journey. The eligibility assessment encompasses 3 critical domains: safety, logistical feasibility, and efficacy considerations. Safety evaluations focus on performance status, organ function, and comorbidities that could complicate major CAR T adverse effects, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and infections.

    Key safety exclusions include active heart failure, unstable coronary artery disease, decompensated cirrhosis, active respiratory disease, neurologic conditions such as parkinsonism or multiple sclerosis, and active infections. Logistical considerations require adequate caregiver support, patient understanding of the process, and availability of bridging therapy options. The trajectory of disease progression is crucial; patients progressing too rapidly may not complete the manufacturing and delivery process successfully.

    Louis Williams, MD,emphasizes that CAR T eligibility differs significantly from autologous stem cell transplant criteria, with more patients potentially eligible for CAR T due to the absence of myeloablative conditioning. Real-world data suggests that many patients successfully treated with CAR T therapy would not have met strict clinical trial eligibility criteria, indicating broader applicability in clinical practice than initially anticipated.

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