CAR T-cell and bispecific antibody treatment strategies in RRMM: A real-world study

Results from a retrospective, multicenter, real-world cohort study evaluating chimeric antigen receptor (CAR) T-cell therapies and bispecific antibodies (BsAbs) used alone or sequentially in patients with relapsed/refractory multiple myeloma (RRMM) were published in Blood Cancer Discovery by Merz et al. Patients (N = 640) who had received ≥3 prior lines of therapy (LoT) were initially treated with CAR T-cell therapy (n = 399) or a BsAb (n = 241). The primary endpoint was overall survival (OS).

Key data: At a median follow-up of 14.3 months for CAR T-cell recipients and 9.9 months for BsAb recipients, multistate-derived probabilities of survival at 6, 12, and 18 months were 93%, 86%, and 79% with CAR T-cell-first treatment vs 79%, 69%, and 63% with BsAb-first treatment, respectively (p < 0.001). CAR T-cell-first treatment was associated with a lower risk of progression during initial immunotherapy compared with BsAb-first treatment (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.63–0.98), while the risk of death following progression was similar between initial treatment modalities. In multivariable modeling, ciltacabtagene autoleucel (cilta-cel) / cesnicabtagene autoleucel (cesni-cel) was associated with longer progression-free survival (PFS; HR, 0.27; 95% CI, 0.19–0.40) and OS (HR, 0.30; 95% CI, 0.16–0.56) compared with idecabtagene vicleucel (ide-cel). Outcomes with BsAbs were comparable with ide-cel for PFS (HR, 0.72; 95% CI, 0.52–1.01) and OS (HR, 0.77; 95% CI, 0.51–1.17). 

Key learning: In this exploratory real-world analysis, CAR T-cell-first treatment, particularly with cilta-cel and cesni-cel, was associated with higher survival probabilities in RRMM compared with BsAb-first treatment. Prospective studies are required to establish whether a specific CAR T-cell / BsAb sequence independently improves outcomes.