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ASCO 2026 | Dexamethasone prophylaxis in myeloma with excessive lymphocyte expansion after cilta-cel infusion
In this video, Peter Forsberg, MD, Colorado Blood Cancer Institute, Denver, CO, discusses the potential role of dexamethasone prophylaxis in patients with multiple myeloma (MM) who exhibit excessive lymphocyte expansion after ciltacabtagene autoleucel (cilta-cel) infusion, highlighting its use to mitigate atypical neurotoxicities and other adverse events associated with this CAR T-cell product. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
Cilta-cel, you know, is the primary CAR-T that we’re using in clinical practice for multiple myeloma currently. It has a complex side effect profile, you know, including, you know, hard to predict events, including atypical neurotoxicity, immune effector cell-associated enterocolitis, cranial nerve palsies. You know, one risk factor that we’ve identified that is associated with the development of some of these late atypical toxicities is excessive expansion of lymphocytes following CAR-T administration...
Cilta-cel, you know, is the primary CAR-T that we’re using in clinical practice for multiple myeloma currently. It has a complex side effect profile, you know, including, you know, hard to predict events, including atypical neurotoxicity, immune effector cell-associated enterocolitis, cranial nerve palsies. You know, one risk factor that we’ve identified that is associated with the development of some of these late atypical toxicities is excessive expansion of lymphocytes following CAR-T administration. So pretty consistently between days 11 and 14 post CAR-T administration, we can monitor lymphocyte expansion. And we developed an approach to deal with excessive expansion. In our initial protocol, it was greater than 5,000 lymphocytes in the peripheral blood, we’ve adjusted that down to 3,000. And essentially, we developed a strategy to use dexamethasone dosing, a structured protocol over three days to try to reduce the lymphocyte count and try to preempt the emergence later of some of these atypical neurotoxicities. And we think it’s helped in terms of developing a safe strategy to mitigate some of the risks intrinsic to Carvykti therapy.
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