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Tandem Meetings 2026 | Adverse events to monitor for following cilta-cel infusion in myeloma: early-onset CRS & IEC-EC
In this video, Kenneth Lim, MBBS, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia, highlights some adverse events (AEs) that physicians should be aware of when treating patients with multiple myeloma (MM) with ciltacabtagene autoleucel (cilta-cel). Dr Lim notes that cytokine release syndrome (CRS) can often occur earlier post-infusion with cilta-cel than with CAR-T constructs used in lymphoma, underscoring the importance of monitoring for early-onset CRS. He also mentions the risk of immune effector cell-associated enterocolitis (IEC-EC), which is characterized by substantial and prolonged diarrhea and can be potentially life-threatening if not managed effectively. This interview took place virtually.
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Transcript
I think the timing of CRS is also important, unlike because obviously with the lymphoma CARs coming earlier, we have seen the CRS occurring in patients in the first week of CAR infusion. However, what we noted with cilta-cel is that the CRS tends to occur a bit later. So if a patient who is being infused with cilta-cel comes in day one, day two, day three with a fever, early-onset CRS, that is considered high-risk, suggestive of a more inflammatory profile, and patients should be monitored more closely when they come in with early-onset CRS...
I think the timing of CRS is also important, unlike because obviously with the lymphoma CARs coming earlier, we have seen the CRS occurring in patients in the first week of CAR infusion. However, what we noted with cilta-cel is that the CRS tends to occur a bit later. So if a patient who is being infused with cilta-cel comes in day one, day two, day three with a fever, early-onset CRS, that is considered high-risk, suggestive of a more inflammatory profile, and patients should be monitored more closely when they come in with early-onset CRS. What we found as well with cilta-cel is that the ICANS rates were not as high as the lymphoma CARs, but the rates of ICANS are a lot lower than what we see in the lymphoma CARs. So I think not all CARs are built differently, but I think most people do not know that CRS for the cilta-cel cohort does occur a bit later.
The other thing as well, which hopefully we can get our study published, we did have an abstract last year talking at Tandem and subsequently at EHA 2025 documenting IEC-enterocolitis. And what we see is that these patients can present up to three months after cilta-cel infusion. And we still do not know the pathophysiology of this, and hopefully there will be more consortiums, there will be a consortium sort of collaboration trying to basically document the experiences of different centers with managing this and diagnosing this entity. But I think a lot of people do not realize that once they go home from the CAR-T centers, particularly after a month of monitoring, patients can present with profuse diarrhea three months later. We have found certain risk factors for that, and then it was previously presented at Tandem, and what we found was that patients who had delayed neurotoxicity within the first three weeks, there was maybe about eight to 10 times increased odds of subsequently developing IEC-colitis. In terms of the incidence of that or how prevalent that is in cilta-cel-infused patients, we are seeing it at a rate of maybe about 2% to 3% of patients. Although the risk is small, patients prior to getting consented to receive cilta-cel therapy should be aware of this risk because it can prove highly debilitating and a lot of times the symptoms persist and do not resolve.
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