CAR-T Meeting 2024 | Selecting patients with myeloma for CAR-T: important clinical considerations

Multiple myeloma now has two licensed CAR T-cell products, so we’re trying to ascertain the best patients which we should be using. One of the things which is becoming apparent, or the patients not to use, are the patients with aggressive, widespread relapse because essentially the outcome of those patients is poor and we also see lots of CRS and ICANS.

So really what we’re trying to do is to select your patients, or if you do have a patient in that setting is to give adequate bridging therapy. What we know with cilta-cel is that the risks of getting the late neurotoxicity that we see is associated with significant disease burden and high CAR-T expansion and CRS, and we have to manage that very rapidly.

So back to the original question, we have to select those patients more appropriately as having a lower disease burden or if we can’t do that, we’d have to give adequate bridging therapy for that.

The second problem is that we are seeing that we are unable to give the CAR T-cell product due to worsening disease in the manufacturing process. So again, what we’re looking for is patients with a slightly lower disease burden, a slightly lower disease tempo and lower extramedullary disease. These are the patients who are going to do much better with CAR T-cell therapy.