Real-world patient cases: CAR T-cell therapy

During the European Hematology Association (EHA) 2023 Hybrid Congress, the Lymphoma Hub and Multiple Myeloma Hub held a joint satellite session on the ins and outs of CAR T-cells in the real world. 

Here the Multiple Myeloma Hub is pleased to share a real-world patient case as presented by Doris Hansen, Moffitt Cancer Center, Tampa, US.

Here, Hansen discusses a case study of a 78-year-old caucasian male with multiple comorbidities and prior exposure to a BCMA-directed agent (Figure 1), they were treated with idecabtagene vicleucel (ide-cel). Hansen uses the case study to examine real-world safety and efficacy data for both ide-cel (Figure 2) and ciltacabtagene autoleucel (cilta-cel), making comparisons with clinical trial data from KarMMa and CARTITUDE-1.¹

Figure 1. Patient case study outline* 

BCMA, B-cell maturation antigen; CAD/NSTEMI, coronary artery disease/non-ST-elevation myocardial infarction; CAR, chimeric antigen receptor; cyclo; cyclophosphamide; dara, daratumumab; d, dexamethasone; ECOG, Eastern Cooperative Oncology Group; EF, ejection fraction; HCT, hematopoietic stem cell transplant; IDDM, insulin-dependent diabetes mellitus 2; ide-cel, idecabtagene vicleucel; Ig, immunoglobulin; Isa, isatuximab; Ixa, ixazomib; K, carfilzomib; MM, multiple myeloma; P, pomalidomide; R, lenalidomide; R-ISS, revised International Staging System; s/p, status post; T, thalidomide; V, bortezomib
*Provided by Hansen.¹

Figure 2. Safety of ide-cel in the real-world setting* 

CRS, cytokine release syndrome; ide-cel, idecabtagene vicleucel; NRM, non-relapse mortality; NT, neurotoxicity; SOC, standard of care.
*Adapted from Hansen, et al.^2
†ASTCT criteria used for grading CRS and NT.

Watch or download the presentation to learn more about:

• The safety and efficacy of ide-cel and cilta-cel in the real world compared with clinical trial data
• The factors associated with poorer response to CAR T cells
• The discrepancy between real-world patient characteristics and eligibility criteria for clinical trials of CAR T cells
• The use of CAR therapies in patients ineligible for clinical trials

Key points^1,2

• Best overall response rate to ide-cel and cilta-cel in standard of care setting, 84% and 89%, respectively.
• Factors associated with poorer response to ide-cel include,
  • prior use of BCMA-targeted therapies;
  • high-risk cytogenetics;
  • ECOG performance status ≥2; and
  • younger age.
• High-risk cytogenetics were an independent predictor of inferior outcomes with cilta-cel use.
• Overall, ≥50% of real-world patients with multiple myeloma are ineligible for enrollment in clinical trials of CAR T cells but demonstrated favorable safety and efficacy data in the standard-of-care setting, compared with KarMMa and CARTITUDE-1.
• Treatment with CAR T-cell therapies such as ide-cel and cilta-cel is feasible in the real-world setting, including in patients ineligible for clinical trial