IMS 2026 | CAR T-cell therapy in R/R myeloma: adverse-event management costs and treatment selection

Absolutely. So one of the posters I’ll be presenting here is a product-agnostic description of some of these rare AEs, rare toxicities of CAR-T therapy. A lot of centers, both in the U.S., are considering, you know, do I need two or three or four CAR-T therapies or is one sufficient? And in other countries, as you know, many regulatory and healthcare payers specifically look at cost-effectiveness of studies. Most CAR-T cost-effectiveness analyses focus on CRS and ICANS. Neurotoxicity is the only morbidity in question. There’s a lot more that can happen to these patients, in particular, IEC-HS, which is HLH, hemophagocytosis. These atypical neurotoxicities can happen, like Parkinsonism, neuro positives, et cetera. And most recently, IEC enterocolitis has been described by our group and others looking at this kind of intractable diarrhea after CAR-T therapy. I think the bottom line is that they are expensive. Honestly, IEC enterocolitis is more expensive than CRS. There’s no doubt about that. In these severe cases, these patients are being hospitalized. They’re needing total parenteral nutrition (TPN), nutrition consult, profoundly deconditioned, needing profound biologics. So I think the biggest takeaway is that we need a better understanding of, number one, how to treat those patients, and number two, how to identify those patients. There’s a lot of work in the last year showing, for example, that increased CAR expansion, as manifested by a rapid rise in absolute lymphocyte count, can predict Parkinsonism and nerve palsies. It does not predict enterocolitis, to my understanding. We need a better understanding of it. Should this be used to decide between CAR-T therapies in the U.S.? I would say no. In any country, I would say no. But here, at least, if it’s approved, I wouldn’t go just off of that. Because ultimately, it depends so much on patient preference. You know, a lot of patients are going to be looking for the data with the biggest track record of curing patients. That’s cilta-cel. Others will be looking for the one with potentially the fewest rare side effects, at least as of now, that appears to be anito-cel. Some are looking for the safest product altogether, that may be ide-cel. Each product has its niche. I’m planning to have all three products available once anito-cel is FDA approved. And even then, it is a long discussion. It was just two for me to decide for my patients which one is which. So I would hesitate against, I would advise against making a decision on which CAR-T therapy to do or approve purely based on the AE costs. But I think it’s worth noting that they are very expensive. And as you are getting these on board, remember that these delayed toxicities may end up being more expensive than the acute things that you focus on when the patient is then and there. So we need to both understand the better toxicities and have a plan to have the patient come back and be treated expeditiously for them.

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