Study Finds High Mortality Rate in Patients on CAR-T Waitlist

The mortality rate was more than 80% in a group of patients with relapsed or refractory multiple myeloma (MM) who were on the waitlist for a chimeric antigen receptor (CAR) T-cell therapy but did not secure a production slot, according to a recent study.

Nausheen Ahmed, MD, of the University of Kansas Cancer Center and colleagues conducted the study because idecabtagene vicleucel (ide-cel) has shown “promising outcomes” but there are “limited” apheresis and production slots.

Dr. Ahmed and colleagues evaluated the outcomes of patients at a single center who were on the waitlist to receive ide-cel in 2021 but could not secure a slot. They conducted a retrospective chart review of patients with relapsed or refractory MM who were evaluated for ide-cel between March 2021 and July 2021. They performed a survival analysis using the Kaplan-Meier Survival estimator.

Researchers Evaluate Outcomes of Patients on Waitlist for Ide-cel

They found that 40 patients who were eligible to receive CAR-T therapy were on the waitlist to receive ide-cel. The median patient age was 61 years. Of the 40 eligible patients, 60% secured a production slot and 40% did not secure a production slot at a median follow-up of 14 months. There was a median of two production slots per month from March 2021 to October 2021 (range, zero to nine). All slots were filled.

The median time from consult to collection was 38 days and the median time from collection to infusion was 42 days. The median overall survival was not reached in the patients who secured a production slot, while it was nine months in those who did not (P<.001).

The mortality rate was 81% in the group of patients who did not receive CAR-T. In the patients who received ide-cel, 38% died due to progressive disease.

“Many patients who were eligible for ide-cel were not able to secure a timely slot in 2021. Mortality was higher in this group, due to a lack of comparable alternatives,” Dr. Ahmed and colleagues concluded. “Increasing alternate options as well as improvement in manufacturing and access is an area of high importance to improve [relapsed or refractory] MM outcomes.”

Reference

Ahmed N, Wesson W, Mushtaq MU, et al. “Waitlist mortality” is high for myeloma patients with limited access to BCMA therapy. Front Oncol. 2023;13. doi:10.3389/fonc.2023.1206715