Associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center

Krina K. Patel, MD, MSc

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spoke with Krina K. Patel, MD, MSc, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, about mitigating CAR T-cell therapy–related cytokine release syndrome (CRS) in multiple myeloma.

Patel discussed key toxicities seen with CAR T-cell therapy, such as CRS and neurotoxicity in lymphoma and multiple myeloma. CRS is the largest concern in multiple myeloma, Patel said. These toxicities are limiting factors in CAR T-cell therapy use in hematologic malignancies.

CRS often presents as grade 1 fever that responds to acetaminophen. Moreover, fevers are a good sign that the CAR T-cell therapy is working rather than indicative of a serious toxicity, such as sepsis, Patel explains.

However, in cases of higher-grade fevers that are accompanied by hypoxia or hypotension, tocilizumab (Actemra) can be considered, Patel says. Many patients with COVID-19 were treated with tocilizumab, which led to a shortage of the agent for patients with multiple myeloma receiving CAR T-cell therapy. As such, other options to treat CRS were utilized, including dexamethasone and IL-6 inhibitors like siltuximab (Sylvant), which elicited rapid responses, Patel concludes.

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The associate professor from The University of Texas MD Anderson Cancer Center discussed mitigating CAR T-cell therapy–related cytokine release syndrome in multiple myeloma.

Mitigating Cytokine Release Syndrome in CAR T for Multiple Myeloma: Krina K. Patel, MD, MSc

spoke with Krina K. Patel, MD, MSc, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, about the integration of CAR T-cell therapy into the treatment paradigm of relapsed/refractory multiple myeloma.

Patel discussed how having an FDA-approved CAR T-cell therapy, idecabtagene vicleucel (ide-cel; Abecma),has significantly advanced the treatment of patients with heavily pretreated, relapsed/refractory multiple myeloma, with the demand for ide-cel currently outweighing the supply. She stated that many patients receiving ide-cel are unfit for clinical trials because of kidney function impairment or non-secretory disease, so having any FDA-approved options in this setting is significant. In addition to ide-cel, a second CAR T-cell therapy, ciltacabtagene autoleucel, may also be approved, further expanding treatment options for this patient population, Patel says.

Although these therapies are not curative, patients are able to derive substantial responses with a single dose of therapy, Patel says. The response rates with CAR T-cell therapies are in the range of 80% to 100% compared with about 30% for other approved agents for this patient population. Moreover, the progression-free survival can surpass 1 year with some products. Ultimately, offering a potential treatment-free interval to patients with heavily pretreated disease is a significant achievement, Patel concludes.

The associate professor from The University of Texas MD Anderson Cancer Center discussed the integration of CAR T-cell therapy into the treatment paradigm of R/R MM.

Integrating CAR T Therapy in Multiple Myeloma: Krina K. Patel, MD, MSc

The associate professor from The University of Texas MD Anderson Cancer Center discussed future research with CAR T therapy in multiple myeloma.

Krina K. Patel, MD, MSc

Articles

Mitigating Cytokine Release Syndrome in CAR T for Multiple Myeloma: Krina K. Patel, MD, MSc

Integrating CAR T Therapy in Multiple Myeloma: Krina K. Patel, MD, MSc

Future CAR T Therapy Research in Multiple Myeloma: Krina K. Patel, MD, MSc