Patient Perspectives: Response and Adverse Effects to CAR T in R/R MM
Panelists discuss how patients typically respond well to chimeric antigen receptor (CAR) T-cell therapy with manageable adverse effects (AEs), including expected cytokine release syndrome (CRS) presenting as fever, whereas rare neurotoxicity is closely monitored through frequent cognitive testing and treated with steroids and late immune system effects like urinary tract infections (UTIs), respiratory infections, and shingles occur in the first 6 months post treatment but resolve with appropriate medications and prophylactic treatments, with outcomes improving significantly when CAR T is used earlier in treatment lines rather than after patients have exhausted all other options.
EP: 1.Overview of Multiple Myeloma
EP: 2.Patient Perspectives: Initial Diagnosis of Multiple Myeloma
EP: 3.Multidisciplinary Approaches in Coordinating Care for CAR T Therapy and Patients With Myeloma
EP: 4.Shared Resources and Patient Education for Multiple Myeloma
EP: 5.R/R Multiple Myeloma: Patient Perspectives and Clinical Guidance Upon Diagnosis
EP: 6.Shared Clinical Decision-Making in CAR T Therapy for R/R MM
EP: 7.Nursing Perspectives on Ensuring Patient Success for CAR T Therapy in R/R MM
EP: 8.Patient Perspectives: Response and Adverse Effects to CAR T in R/R MM
The patient experienced a positive response to CAR T therapy with manageable AEs during her 7-day hospitalization. She developed fever twice, which initially concerned her until the medical team explained that fever indicates the CAR T cells are working effectively by proliferating and targeting the myeloma cells. This condition, called CRS, was anticipated by the staff and promptly treated with tocilizumab to control the fever. Additional AEs included nausea, stomach pain, and significant fatigue, all of which were well managed with appropriate medications. Importantly, she did not experience neurotoxicity, particularly memory loss, which had been her primary concern before treatment.
The medical team employs comprehensive monitoring protocols to manage both early and late CAR T toxicities. Early toxicities include CRS, treated immediately with tocilizumab, and rare neurotoxicity, monitored through frequent cognitive assessments including sentence writing, counting backward, and object naming every 4 hours. When neurotoxicity occurs, it’s treated with dexamethasone and escalated to additional therapies like anakinra if needed. Moving CAR T therapy to earlier treatment lines has significantly reduced severe AEs, with serious neurological complications decreasing from 6% in original studies to approximately 1% in current second-line applications.
Late toxicities primarily involve immune system suppression during the first 6 months post treatment, requiring prophylactic medications including acyclovir and trimethoprim/sulfamethoxazole (Bactrim) to prevent opportunistic infections and shingles. The patient experienced typical post–CAR T infections, including 2 UTIs, an upper respiratory infection, and shingles, all of which were promptly treated with appropriate medications and resolved without prolonged complications. The medical team has proactively implemented intravenous immunoglobulin therapy to boost patients’ immune systems and prevent infections, showing positive results. Recovery time is crucial, as the immune system gradually recovers with distance from treatment, ultimately allowing patients to return to normal immune function.
