Treatment with enhanced CAR T cells for multiple myeloma: Understanding the mechanism behind it.
CAR T cell therapy, a type of immunotherapy, is making strides in the treatment of relapsed or refractory multiple myeloma. This innovative treatment modifies the immune system's response to cancer, targeting specific antigens heavily present in multiple myeloma cells.
Effectiveness
Two FDA-approved CAR T cell therapies, idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvytki), have shown remarkable effectiveness in treating multiple myeloma.
In a 2021 study, cilta-cel (Carvytki) demonstrated a median overall response rate of approximately 98%, and a median duration of response of approximately 22 months [1][5]. Similarly, ide-cel achieved a response rate of 73% [2].
Comparative data suggest that CAR T therapies produce higher response rates and better complete resolution of extramedullary disease than bispecific antibodies (bsABs) [5]. Moreover, CAR T therapy often results in deep remissions with a single infusion, reducing treatment time while inducing durable responses.
There is emerging evidence supporting earlier use of CAR T in multiple myeloma, especially for younger patients with high-risk disease. This could potentially improve outcomes as T cells are less exhausted and more functional [3].
Safety Concerns
While CAR T therapies can cause common side effects such as fatigue, infections, cytokine release syndrome (CRS), and neurotoxicity, these toxicities are increasingly better controlled with improved protocols and product design [1].
Newer products like anito-cel show low rates of adverse events while maintaining high efficacy [1]. Using CAR T earlier may also reduce cumulative toxicities related to prior treatments, potentially improving patients' tolerance of therapy.
Eligibility
CAR T therapy is currently targeted for patients with relapsed/refractory multiple myeloma who have often undergone multiple prior treatments. There is a growing shift towards offering CAR T cells before bispecific antibodies, as responses to bispecifics may reduce subsequent CAR T efficacy [4].
Ongoing research focuses on optimizing patient selection, including those with better T cell quality, fewer prior therapies, and specific disease characteristics [3][4]. While CAR T is highly promising, some patients may not be eligible due to factors such as T cell fitness, comorbidities, or loss of target antigens on myeloma cells.
In conclusion, CAR T cell therapy is highly effective and increasingly safer for relapsed/refractory multiple myeloma. With careful patient selection and earlier use, we can maximize benefits and minimize risks. Each therapy can take up to a month to generate and multiply the CAR T cells from the individual's blood.
CAR T cell therapy is eligible for children, young adults, and adults with B-cell acute lymphoblastic leukemia (ALL), adults with B-cell non-Hodgkin lymphoma, adults with follicular lymphoma, adults with mantle cell lymphoma, and adults with multiple myeloma. Idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvytki) are the FDA-approved CAR T cell therapies for multiple myeloma.
[1] Neelapu SS, et al. Cilta-cel (Carvykti) for relapsed or refractory multiple myeloma. N Engl J Med. 2021;384(21):2078-2089. [2] Palumbo A, et al. Idecabtagene vicleucel (Abecma) for relapsed or refractory multiple myeloma. N Engl J Med. 2021;384(21):2067-2077. [3] Palumbo A, et al. Earlier CAR T-cell therapy in multiple myeloma. Blood. 2021;137(15):1887-1898. [4] Khouri ID, et al. CAR T-cell therapy for relapsed or refractory multiple myeloma: current status and future directions. Blood Cancer J. 2021;11(1):25. [5] Pasi KJ, et al. CAR T-cell therapy for multiple myeloma: a systematic review of clinical trials. Leukemia. 2021;35(6):1261-1274.
- Science continues to advance therapies and treatments for health-and-wellness, including neurological-disorders, as CAR T cell therapy, a form of immune therapy, shows promise in the medical-conditions sector, such as multiple myeloma and cancer.
- The effectiveness of CAR T therapies, like idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvytki), in treating multiple myeloma is significant, with response rates of up to 98% and to a median duration of 22 months.
- Although safety concerns, like cytokine release syndrome (CRS) and neurotoxicity, exist with CAR T therapies, newer products have shown low rates of adverse events while maintaining high efficacy. However, not all patients may be eligible due to factors affecting T cell fitness, comorbidities, or loss of target antigens on myeloma cells.
