Being able to access each myeloma patient individually and select the treatment path that is most effective is my definition of precision medicine. While the 65th Annual American Society of Hematology Conference and Exposition (ASH) is filled with abstracts about future therapies, many studies are retrospective. The goal of these is to look back at patients who’ve received certain treatments and assess how they performed and what factors led to certain outcomes. This look backward will ultimately help future patients.
The goal of offering a more precise treatment journey can reduce toxicity, expense, and stress for patients. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are well-documented side effects when receiving CAR T-cell therapy. We know that the time to onset of these side effects varies by which of the two approved CAR T-cell therapies is administered CARVYKTI (ciltacabtagene autoleucel) or Abecma (idecabtagene vicleucel). However, it’s not quite as clear which patients may have more severe reactions or the best outcomes.
A study presented on Saturday by Darren Pan, MD, looked back at patients, like me, who have received CAR T-cell therapy. The goal was to understand if certain lab values associated with inflammation can help physicians understand who is at greater risk for CRS and ICANS? And maybe more importantly do these values predict progression-free survival and overall survival? This study reviewed myeloma patients who underwent CAR T-cell therapy at Mount Sinai Hospital between 2017 and 2023 45 with CARVYKTI, 37 with Abecma, and 19 with other products administered through clinical trials. The study identified markers that are associated with inflammation and compared pre-CAR T-cell and post-CAR T-cell therapy levels. A primary question they asked is did baseline (pre-CAR T) lab values correlate to outcomes? The study concluded that higher fibrinogen and ferritin values at baseline were associated with inferior overall survival after CAR T-cell therapy. Higher baseline absolute lymphocyte counts were linked to a higher risk of ICANS and higher grade of ICANS, an important toxicity to consider for patients receiving CAR T. And higher ferritin equated to shorter progression-free survival. CAR T-cell therapy is a highly effective treatment option, but outcomes and duration of response can vary widely, so if we can use widely available tests to help determine outcomes, this could possibly impact treatment decisions. For full details, Inflammatory Biomarkers and Outcomes in Multiple Myeloma Patients after CAR T-Cell Therapy
My CAR T-cell therapy cost $1.4 million which is not a number to take lightly, nor were the weeks away from home/work to undergo this therapy. The results of my CAR T-cell therapy produced positive results, so I’m thrilled to have had the opportunity to get it. But, if retrospective studies can help determine who will get a longer duration of responses with one therapy versus another and who might be at less risk of side effects that require hospitalization, we can make better-informed treatment decisions when evaluating treatment options with our myeloma specialist and perhaps reduce the cost by reducing or eliminating hospitalization.
There are 2 more FULL days of myeloma information to come, so stay tuned to future blogs and postings on X.
— Linda Huguelet, Chattanooga Multiple Myeloma Networking Group
@LindaMYELOMA on X (Twitter)