A real-world study compared the two chimeric antigen receptor (CAR) T-cell therapies idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) for the treatment of relapsed or refractory multiple myeloma (MM) and found that cilta-cel “may offer superior efficacy.”
The retrospective, observational study was led by Maximilian Merz, of the Department of Hematology, Cellular Therapy, Hemostaseology and Infectious Diseases at the Universitätsklinikum Leipzig in Germany, and published in Hemasphere.
Using an international, multicenter cohort of patients with relapsed or refractory MM, outcomes were compared for ide-cel (n=162) and cilta-cel (n=42).
Median age at the time of infusion was 61 years in both group. Both cohorts received a median of six prior lines of therapy. Median time from apheresis to infusion was 47 days for ide-cel and 68 days for cilta-cel (P<0.001).
Cilta-cel resulted in significantly higher overall response rates (93% vs 79%; P<0.001); complete response at day 30 was 48% with cilta-cel versus 26% with ide-cel (P<0.001). Median follow-up for survivors was 9.7 months with cilta-cel and 12.1 months with ide-cel. The 10-month progression-free survival was 82% with cilta-cel versus 47% with ide-cel (P<0.001) and 10-month overall survival was 90% versus 77%, respectively (P=0.06).
Cytokine release syndrome (CRS) was common in both cohorts, occurring in 81% in the cilta-cel group and 85% in the ide-cel group. The rate of immune-effector cell-associated neurotoxicity syndrome (ICANS) was 19% in both treatment groups. CRS occurred significantly earlier with ide-cel (median, 2 days vs 4 days with ide-cel; P<0.001). Severe CRS and grade 3/4 ICANS was more common in the cilta-cel-treated patients.
A total of 47 deaths occurred—43 in the ide-cel group and four in the cilta-cel group, with relapse or progression being the most common cause of death. Nonrelapse mortality was 5% with cilta-cel and 3% with ide-cel (P=0.51). Cilta-cel had a later peak of CAR-T expansion (day 14 vs day 7 for ide-cel), and cilta-cel expansion was associated with ICANS.
The study was limited by its retrospective design. In addition, treatment choice occurred at the discretion of the treatment center, indicating the potential for selection bias.
“Our study provides real-world evidence that cilta-cel was associated with superior outcomes and distinct cellular dynamics versus ide-cel in triple-class-exposed [relapsed or refractory] MM,” the authors concluded. “Despite comparable and low non-relapse mortality in both treatment groups, the different toxicity profiles of cilta-cel must be taken into account in routine clinical practice.”
Reference
Merz M, Albici AM, von Tresckow B, et al. Idecabtagene vicleucel or ciltacabtagene autoleucel for relapsed or refractory multiple myeloma: an international multicenter study. Hemasphere. 2025;9(1):e70070. doi:10.1002/hem3.70070
