falsefalse

Progress and Promise: Advancing Treatment in Relapsed/Refractory Multiple Myeloma - Episode 2

Positioning CAR T in Early Relapse MM

,

Panelists discuss how chimeric antigen receptor (CAR) T-cell therapy is increasingly being used earlier in the treatment paradigm rather than in the late-stage, with better disease control prior to infusion leading to improved outcomes and reduced toxicity, particularly for high-risk patients or those with functional high-risk disease relapsing sooner than expected.

Video Player is loading.
Current Time 0:00
Duration 0:00
Loaded: 0%
Stream Type LIVE
Remaining Time 0:00
 
1x
  • Chapters
  • descriptions off, selected
  • captions off, selected

    Video content above is prompted by the following:

    Peter Voorhees, MD, advocates for earlier use of CAR T-cell therapy in the treatment paradigm, citing multiple advantages, including better disease control, improved effector-to-target ratios, and superior safety profiles. Earlier intervention allows for more therapeutic options during leukapheresis and bridging therapy, leading to better progression-free survival outcomes and reduced toxicity, including less-severe cytokine release syndrome, cytopenias, and immune effector cell-associated neurotoxicity syndrome development.

    Current FDA approvals support this approach, with cilta-cel approved for first relapse and beyond, while ida-cel is approved for second relapse and beyond. However, patient selection remains crucial: Those with standard-risk disease biology who achieved durable responses to frontline therapy may benefit from alternative second-line therapies. Conversely, patients with high-risk disease biology or those relapsing sooner than expected from frontline therapy are ideal candidates for early CAR T intervention.

    Louis Williams, MD, acknowledges the attrition rates across therapy lines, noting that 60% of transplant-ineligible patients may not progress beyond first-line therapy. While favoring CAR T use after second relapse due to concerns about long-term toxicities and the need for more data on neurocognitive effects and secondary malignancies, he emphasizes individualized decision-making based on disease trajectory and biology. The risk-benefit analysis must consider both the opportunity cost of waiting and the potential for long-term complications.

    x