Dr Garfall on Ide-Cel and Lenalidomide Maintenance in Myeloma After Suboptimal ASCT Response

“We set a bar for ourselves to see if we could increase [the proportion of patients who converted to a complete response (CR)] to at least 30%, and what we found actually was that we did even better than that by a good amount. Sixty-three percent of patients converted to CR, and another 24% upgraded their response in some other way. A total of 87% of patients improved their response to some extent.”

Alfred L. Garfall, MD, MS, associate professor of medicine (hematology-oncology) and director, Autologous Hematopoietic Cell Transplantation, Cell Therapy and Transplant Program, Hospital of the University of Pennsylvania; and section chief, Multiple Myeloma, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, discusses findings from the phase 2 BMT CTN 1902 trial (NCT05032820) evaluating Idecabtagene vicleucel (ide-cel; Abecma) followed by lenalidomide (Revlimid) maintenance in patients with multiple myeloma who had a suboptimal response following up-front autologous stem cell transplant (ASCT) and maintenance lenalidomide. Data were presented at 2025 Transplantation & Cellular Therapy Meetings.

Historically, patients who do not achieve a complete response (CR) following ASCT and lenalidomide maintenance do not typically convert with a CR down the line, Garfall explains, noting that for this study, investigators projected that this happens in approximately 10% of patients. Therefore, the primary end point of the BMT CTN 1902 trial was the CR rate at 6 months following ide-cel infusion with the goal of increasing that rate to at least 30%, Garfall explains.

Findings showed that 63% of patients (n =38) achieved CR, and an additional 24% of patients experienced an upgraded response without reaching CR, leading to an overall response improvement rate of 87%.

Safety findings demonstrated that cytokine release syndrome (CRS) was observed in 81.6% of patients, with all cases limited to grade 1 (68.4%) or grade 2 (13.2%). The median time to CRS onset was 1 day (range, 0-4), with resolution occurring at a median of 2.5 days (range, 0-6). Tocilizumab was administered in 77% of cases, and corticosteroids were used in 23% of patients with CRS. Notably, no cases of immune effector cell–associated neurotoxicity syndrome were reported.