Dr. Costa on Remaining Challenges With CAR T-Cell Therapy in Multiple Myeloma

Luciano J. Costa, MD, PhD, an associate professor of medicine in the Blood and Marrow Transplantation and Cell Therapy Program at the University of Alabama’s Birmingham School of Medicine, discusses remaining challenges with investigational CAR T-cell therapies in relapsed/refractory multiple myeloma.

CAR T-cell therapy, namely idecabtagene vicleucel (ide-cel; bb2121), has demonstrated unprecedented responses with durable remissions in patients with relapsed/refractory disease. Moreover, in July 2020, a biologics license application was submitted to the FDA for ide-cel based on findings from the phase 2 KarMMA trial in which the product elicited a 73% overall response rate in patients with relapsed/refractory disease.

However, problems such as cytokine release syndrome (CRS) need to be overcome to optimize the therapeutic modality, Costa explains. In myeloma, the majority of CRS cases are grade 1 or 2, whereas life-threatening CRS is relatively uncommon.

Additionally, adverse effects such as persistent cytopenia and hypogammaglobulinemia with predisposition for infections remain challenges in this space. Although these events are typically manageable, they can be burdensome to patients and practitioners, concludes Costa.