Do older patients with myeloma respond as well to ide-cel as younger patients?

Older and frail adult patients with multiple myeloma treated with idecabtagene vicleucel (ide-cel), a B-cell maturation agent targeting chimeric antigen receptor (CAR)-T product, have comparable treatment outcomes to younger patients, according to a retrospective analysis.

The research was published online in Blood Advances and led by Othman Salim Akhtar, MD, of the Medical College of Wisconsin and the Center for International Blood and Marrow Transplantation Research in Milwaukee, Wisconsin.

The retrospective study used data from the Center for International Blood and Marrow Transplantation (CIBMTR) on US patients who received ide-cel between May 2021 to June 2023 with at least 100 days of follow-up.

No differences were found in overall response (OR) or complete response (CR) at six months by age group. Progression-free survival (PFS) at six months was higher in patients ≥70 years of age (68.3% vs 60.4%, P=0.02). Overall survival (OS) at six months was comparable between the age groups, (85.5% vs 82.6%, P=0.18). Cytokine release syndrome (CRS) rates (any grade or grade ≥2) were similar across age groups, and prolonged cytopenia or clinically significant infections of any grade did not differ by age group.

Frail adults, defined by a simplified frailty index (SFI) score of ≥2, made up 343 (44.8%) of the patients studied. There were no significant differences in rates of CRS (any grade, or grade ≥3) between frail and nonfrail patients, but frail patients had increased rates of ICANS (any grade, 37% vs 21.5%, P<0.01) and clinically significant infections (49.6% vs 40.9%, P=0.02). There were no differences in OR, CR, PFS, or OS at six months between the two groups. Overall, there were 98 deaths in the frail group and 113 deaths in the nonfrail group. In both frail and nonfrail patients, disease progression was the most common cause of death.

“[T]hese findings provide reassurance that older adults treated with ide-cel, including frail patients, experience comparable efficacy to younger patients,” the authors wrote.

Funding was provided by Bristol Myers Squibb.

Reference

Akhtar OS, Oloyede T, Brazauskas R, et al. Outcomes of older adults and frail patients receiving idecabtagene vicleucel: A CIBMTR study. Blood Adv. 2024. doi:10.1182/bloodadvances.2024014970