Advancing CAR-T therapy in multiple myeloma: a critical appraisal of CARTITUDE-4 and the path toward earlier lines

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The CARTITUDE-4 trial shows that cilta-cel significantly improves overall survival in lenalidomide-refractory multiple myeloma compared to standard care.
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Cilta-cel demonstrated a 62% rate of minimal residual disease negativity, indicating durable responses that translate into survival and quality-of-life gains.
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The trial's no-crossover design raises ethical concerns regarding patient access to cilta-cel after progression, despite providing unbiased OS estimates.
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Safety signals, including grade 3–4 cytopenias and secondary malignancies, necessitate long-term monitoring and careful patient management.
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The trial population's lack of diversity highlights significant implementation challenges in translating findings to older, frailer patients with comorbidities.

Frontiers In Oncology

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