ASH 2020 | Ide-cel in R/R myeloma: patient-reported outcomes and resistance

Nikhil Munshi, MD, Dana-Farber Cancer Institute, Boston, MA, outlines the details of a number of studies investigating idecabtagene vicleucel (ide-cel), a BCMA-targeted chimeric antigen receptor (CAR) T-cell therapy, in relapsed/refractory (R/R) multiple myeloma patients. Firstly, an analysis of secondary health-related quality of life (HRQoL) domains was conducted as part of the phase II KarMMa trial (NCT03361748). The trial, which showed deep responses to ide-cel in myeloma, used questionnaires at baseline, on the day of treatment, throughout and with follow-up to assess the impact of ide-cel on secondary HRQoL domains. Overall, patients showed a clinically meaningful improvement in most functioning and symptom scores with ide-cel treatment. Another study conducted a transcriptomic and genomic analysis of a single patient to investigate mechanisms of resistance to ide-cel. A R/R myeloma patient who had an initial response to ide-cel lasting 8 months, but no response to retreatment at relapse, was analyzed. The results showed that soluble BCMA levels, which fell immediately following T-cell infusion, remained low on relapse, suggesting a lack of BCMA production by myeloma cells. Additionally, genetic analyses found both del(16p) and a BCMA nonsense mutation in myeloma cells, which resulted in biallelic BCMA deletion. This interview took place during the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, 2020.