Chimeric antigen receptor T-cell therapy is equally effective and safe in older (≥70) and younger patients with multiple myeloma: a multicenter retrospective analysis - Report - MDSpire
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Efficacy and Safety of Chimeric Antigen Receptor T-Cell Therapy in Patients with Multiple Myeloma: A Multicenter Retrospective Study Comparing Older and Younger Adults
Clinical Report: Efficacy and Safety of CAR-T Therapy in Multiple Myeloma
Overview
This study evaluates the efficacy and safety of CAR-T therapies in older versus younger adults with relapsed/refractory multiple myeloma. Findings indicate comparable relapse rates but higher non-relapse mortality in older patients, alongside differences in response rates and toxicity profiles.
Background
Chimeric antigen receptor T-cell (CAR-T) therapies have transformed treatment for relapsed/refractory multiple myeloma, particularly with BCMA-directed agents. However, older adults, who represent a significant portion of this patient population, are often underrepresented in clinical trials, raising concerns about the safety and efficacy of these therapies in this demographic.
Data Highlights
Age Group
Cumulative Incidence of Relapse (12 months)
Non-Relapse Mortality (NRM)
12-month PFS Rate
12-month OS Rate
Overall Response Rate
<70 years
48.3% (95% CI: 35.6–59.9%)
6.7% (95% CI: 2.3–14.1%)
43.5% (95% CI: 32.7–57.8%)
74.4% (95% CI: 64.8–85.6%)
78.7%
≥70 years
41.4% (95% CI: 22.3–59.5%)
17.1% (95% CI: 7.1–30.8%)
47.8% (95% CI: 32.8–69.7%)
68.4% (95% CI: 54.3–86.1%)
94.1%
Key Findings
Older patients (≥70 years) had significantly higher comorbidity (CCI ≥ 4: 71.2% vs. 28.1%; p < 0.001).
The overall response rate was higher in older patients (94.1% vs. 78.7%; p = 0.002).
Cumulative incidence of non-relapse mortality was higher in older patients (17.1% vs. 6.7%; p = 0.10).
Severe cytokine release syndrome (CRS; grade >2) occurred in 7.5% of patients overall, with no significant difference between age groups.
Depth of response improved post-infusion, with a higher complete response rate in older patients (58.8% vs. 42.6%).
Clinical Implications
The findings suggest that while CAR-T therapies can be effective in older adults with multiple myeloma, clinicians should be aware of the higher non-relapse mortality and comorbidities in this population. Risk stratification and supportive care strategies may be necessary to optimize outcomes.
Conclusion
This study highlights the need for careful consideration of age-related factors when administering CAR-T therapies in multiple myeloma patients, particularly in older adults.
by Philipp Berning, Markus Maulhardt, Hristo Boyadzhiev, Anca-Maria Albici, Snjezana Janjetovic, Anna Ossami Saidy, Christian Schultze-Florey, Simon Call, Friedrich Stölzel, Annamaria Brioli, Michael Daskalakis, Juliane Knust, Justin Hasenkamp, Rebecca Wurm-Kuczera, Alexander Pohlmann, Matthias Stelljes, Cyrus Khandanpour, Ulrike Bacher, Amelie Boquoi, Florian H. Heidel, Hans Christian Reinhardt, Gerald Wulf, Natalie Schub, Bastian von Tresckow, Georg Lenz, Thomas Pabst, Evgenii Shumilov
