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IMS 2026 | Recognizing and managing delayed enterocolitis after CAR T-cell therapy in multiple myeloma
Yi Lin, MD, PhD, Mayo Clinic, Rochester, MN, discusses the recognition and management of immune effector cell-associated enterocolitis following BCMA-targeted CAR T-cell therapy in multiple myeloma. She highlights persistent or severe diarrhea as a key presenting feature, which can occur several months after infusion and may overlap with infectious causes, and emphasizes early evaluation, exclusion of infection and referral to a CAR T-cell center with gastrointestinal expertise. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
IEC-associated enterocolitis is a more recently identified delayed onset side effect that we’re seeing with BCMA targeting CAR T. It appears to be slightly more common with cilta-cel compared to ide-cel. However, the overall incidence is still on the low side, likely somewhere around 4% of the patients who are infused with cilta-cel. But we don’t quite understand what are the risk features for patients who develop this...
IEC-associated enterocolitis is a more recently identified delayed onset side effect that we’re seeing with BCMA targeting CAR T. It appears to be slightly more common with cilta-cel compared to ide-cel. However, the overall incidence is still on the low side, likely somewhere around 4% of the patients who are infused with cilta-cel. But we don’t quite understand what are the risk features for patients who develop this. The manifestation often is severe diarrhea. And this may come on sometime in the later half of the first month through the first six months post-CAR T infusion. But it’s really most common somewhere in the second to third month post-CAR T infusion. Now, this may still also be the time window where patients may have an occasional viral gastroenteritis or sometimes C. diff colitis. These are all different types of infection that could be common. And in fact, sometimes we see this enterocolitis come on during or shortly after these other causes of diarrhea, where we anticipate the diarrhea to have improved after the treatment period. And so while the initial presentation can be nonspecific, we’re asking the patients, their caregiver, as well as their home primary hematologist to be vigilant for any onset of diarrhea and keep this in their mind in terms of a potential differential. And because we’re all still trying to learn across the CAR T centers how to best intervene, evaluate, and manage, we’re asking right now at Mayo Clinic if patients do develop those symptoms, of course, first rule out any obvious infectious source that could be treated, but very quickly get in touch with us because we do have GI specialists who work with us and have the patient come back and go through a series of testing, including scopes and biopsies of the GI tract to see if the patterns are similar to more of a CAR-T associated enterocolitis that wouldn’t necessarily respond to a treatment for infection.
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