Identifying and Treating Patients With Adverse Prognostic Factors
Panelists discuss the need for consolidation and maintenance strategies following chimeric antigen receptor (CAR) T-cell therapy in patients with high-risk multiple myeloma, highlighting emerging real-world and clinical evidence supporting the use of agents like lenalidomide and bispecific antibodies to extend disease control and improve outcomes in those with historically shorter remissions.
EP: 1.Late-Line R/R: Treatment Landscape
EP: 2.Outcomes and Factors for Consideration When Choosing Between CAR T Therapies
EP: 3.Comparing CAR T Safety, Efficacy in Relapsed/Refractory Multiple Myeloma
EP: 4.Role of Talquetamab as Bridging Therapy for CAR T-Cell Therapy
EP: 5.Optimal Sequencing Strategies for CAR T and Bispecifics in R/R MM
EP: 6.Role of CAR T in Earlier Lines for R/R MM
EP: 7.Non-ICANS and Delayed Neurotoxicity With CAR T: Risk Factors and Ways to Prevent
EP: 8.Real-World Data of SOC Cilta-Cel in R/R MM and Cilta-Cel in Patients With High-Risk Features
EP: 9.Identifying and Treating Patients With Adverse Prognostic Factors
EP: 10.Supportive Care: Infection Disease Prophylaxis and Advice for Community Doctors
EP: 11.Best Practices for Referring Patients for CAR T Therapy
Some patients with multiple myeloma do not achieve durable responses from CAR T-cell therapy alone, particularly those with high-risk disease features. These include individuals with plasma cell leukemia, central nervous system involvement, extramedullary disease, high tumor burden, or adverse inflammatory markers such as elevated ferritin. Although responses to CAR T therapy in these subgroups are often promising, they tend to be shorter lived, with progression-free survival in some studies reported at only 4 to 6 months. This highlights a critical need to enhance outcomes for these patients beyond initial treatment.
To address this gap, consolidation and maintenance strategies following CAR T therapy are gaining attention. Maintenance therapies such as lenalidomide have shown potential in improving outcomes, even achieving high response rates in some consolidation studies. Bispecific antibodies, targeting B-cell maturation antigen or other antigens like GPRC5D, are also being evaluated for maintenance. Early clinical efforts suggest that using bispecifics post CAR T may help maintain disease control by compensating for the limited persistence of infused CAR T cells, essentially providing continuous antigen targeting and immune activation.
Ongoing trials are exploring various dosing schedules and target selection strategies for bispecific maintenance, tailored to the risk profile of the patient. In practice, clinicians are starting to implement these approaches in those with the highest risk, such as those with adverse cytogenetics or prior extramedullary disease. As the field evolves, the integration of personalized maintenance therapies could redefine outcomes for patients who historically have not done well with CAR T alone. Continued research, collaboration, and real-world data will be essential in refining these strategies and determining which combinations yield the most durable benefit.
