Idecabtagene vicleucel (Ide-cel), a CAR T-cell therapy, has shown comparable safety and efficacy in older patients with multiple myeloma (MM) compared to their younger counterparts, according to a recent multicenter retrospective study. The findings, which take into account geriatric characteristics such as comorbidities and organ dysfunction, suggest that these factors do not significantly impede the treatment's effectiveness.
MM is a hematologic malignancy commonly diagnosed in older adults, with a median age of 69 years at diagnosis. While advancements like immunotherapies and CAR T-cell therapy have improved outcomes, their benefits have largely been observed in younger patients. This study addresses the limited data on clinical outcomes in older patients receiving CAR T-cell therapy, especially considering comorbidities, frailty, and organ dysfunction.
Study Details and Patient Characteristics
The retrospective analysis included 156 patients across five centers in the United States, divided into two groups: those under 65 years (n = 81) and those 65 years or older (n = 75). Data were collected from leukapheresis to Ide-cel infusion until November 2023, with a median follow-up of 14.2 months.
Efficacy Outcomes
At the 14.2-month follow-up, older patients (median age 69 years, range 65-83) demonstrated an overall response rate (ORR) of 86.7%. The median progression-free survival (PFS) was 9.1 months, and the median overall survival (OS) was 26.5 months. Notably, 66.7% of older patients were considered frail, and 77.3% did not meet the eligibility criteria for the KarMMa trial, which initially led to Ide-cel's approval.
Safety Profile
Treatment-related adverse events were manageable. Grade ≥3 cytokine-release syndrome occurred in 1% of older patients, and immune effector cell–associated neurotoxicity syndrome was observed in 4%. The study highlighted that older patients had a significantly higher prevalence of frailty, polypharmacy (≥5 drugs; 97%), ≥4 comorbidities (69%), and organ dysfunction (35%; P < .05) compared to younger patients.
Implications for Clinical Practice
These findings provide more comprehensive data on the safety and efficacy of Ide-cel in older patients, indicating that their treatment outcomes are comparable to younger patients. The study authors advocate for more inclusive clinical trial criteria to better represent older patients with MM, thereby optimizing their treatment outcomes and identifying those who could benefit most from Ide-cel. This is particularly relevant given that Ide-cel targets BCMA, a protein highly expressed on malignant MM cells, and is one of the two FDA-approved BCMA-directed therapies, offering a crucial treatment option for relapsed or refractory MM after multiple prior lines of therapy.
