A study presented at the 66th American Society of Hematology Annual Meeting & Exposition compared the efficacy and toxicity of idecabtagene vicleucel (ide-cel) in patients with multiple myeloma (MM) aged 70 years and older versus younger patients.
The multicenter cohort study included 136 patients with relapsed or refractory MM receiving ide-cel treatment at seven tertiary German centers. Patients were grouped by age at the time of chimeric antigen receptor (CAR) T-cell infusion, either younger than 70 years (n=91; median age, 61) or aged 70 years and older (n=45; median age, 72). Both groups had a median of five prior lines of therapy (P=.49) and shared similar characteristics regarding Eastern Cooperative Oncology Group score 0-2 (74.4% vs 84.4%, P=.27), Revised Multiple Myeloma International Staging System stage III at diagnosis (28.6% vs 42.2%, P=.38), high-risk cytogenetics (51.8% vs 35.9%, P=.12), median time from first diagnosis to CAR T-cell infusion (6.9 vs 8.0 years, P=.26), penta-refractory status (51.6% vs 62.2%, P=.36), prior B-cell maturation antigen-directed therapy (14.4% vs 15.6%, P=1.0), and prior autologous hematopoietic stem cell transplantation.
Grade 3 or 4 cytokine release syndrome (CRS) occurred in 7.7% of patients in the younger group and in 4.4% of patients in the older group (P=.71). All grades of immune effector cell–associated neurotoxicity syndrome (ICANS) occurred in 24.4% of patients in the younger group and in 6.6% of patients in the older group (P=.005). The rate of grade 3 or 4 ICANS was similar between the two groups (0% vs 2.2%, respectively; P=1.0), as well as the rate of infections within 30 days after infusion (P=.19).
The overall response rates were comparable between younger patients and older patients (87.8% vs 92.7%, respectively; P=.274). With a median follow-up of 8.1 months, the median progression-free survival (PFS) was 9.2 months (95% CI, 6.7-14.1) for the younger group and 9.6 months (95% CI, 6.9-not reached) for the older group (P=.39). The one-year PFS rates were 42.9% and 48.7%, respectively.
The median overall survival (OS) was not reached, but the one-year OS was 67.1% in the younger group and 66.8% in the older group (P=.95). The cumulative incidence of one-year nonrelapse mortality (P=.17) and the cumulative relapse incidence (P=.08) were comparable in the two groups.
In a multivariate regression analysis, covariates included age groups, number of treatment lines, and disease status before CAR T-cell therapy. The only factor associated with decreased PFS was extramedullary disease at initiation of CAR T-cell therapy (hazard ratio, 1.96; 95% CI, 1.11-3.48; P=.021).
“With the paucity of long-term data, our real-world analysis provides additional support that CAR T-cell therapy is feasible and effective in patients with r/r [relapsed or refractory] MM aged 70 years or older, demonstrating outcomes and toxicities comparable to those observed in younger patients,” the researchers concluded. “Therefore, CAR T-cell therapy should not be withheld for eligible patients above 70 years with r/r MM.”
Reference
Berning P, Maulhardt M, Boyadzhiev H, et al. Idecabtagene vicleucel (ide-cel) shows similar efficacy and toxicity in patients with multiple myeloma aged 70 and older compared to younger patients: a multicenter cohort study. Abstract #3383. Presented at the 66th American Society of Hematology Annual Meeting & Exposition; December 7-10, 2024; San Diego, California.