Shambavi Richard, MD, on Extramedullary Relapse Post CAR-T in Myeloma

Shambavi Richard, MD, of the Icahn School of Medicine at Mount Sinai, discusses a retrospective study on extramedullary disease and chimeric antigen receptor (CAR) T-cell therapy outcomes in multiple myeloma. Dr. Richard and colleagues presented their findings at the 2022 American Society of Hematology Annual Meeting and Exposition.

It was important to conduct the research, she said, because even with novel therapies, patients who have extramedullary disease don’t do as well as other patients.

“We know CAR-T has had impressive results in response rates, depth of response, and progression-free survival,” Dr. Richard said. “And the question in our minds has been, ‘Is it going to perform as well with extramedullary disease?’”

Dr. Richard and colleagues conducted a retrospective review of 85 patients with relapsed or refractory multiple myeloma who received CAR-T. Around one-quarter of patients had extramedullary disease prior to CAR-T and 56.5% of all patients relapsed, including 22.4% of patients with extramedullary disease.

Of the patients with extramedullary disease before CAR-T, 50% relapsed, while 40.9% relapsed with extramedullary disease.

The study showed the median progression-free survival (PFS) was 12 months for patients with extramedullary disease, shorter than the median PFS of 18 months for the overall group.

“It’s very interesting that CAR-T seems to be pretty effective at eradicating extramedullary disease to a certain extent,” Dr. Richard said.

However, in light of these results, it will be “important have both serial PET imaging as well as bone marrow surveillance,” she said.