ASH 2025 | A real-world analysis of infections in patients with RRMM receiving ide-cel

So in CD19-targeted lymphoma space, there is significant data both in leukemia and lymphoma on infections and immune reconstitution. However, the data on infections in multiple myeloma space is pretty scanty. And the existing literature that we have is entirely around viral infections and come from small single centers. Hence, what we did, we designed this study, including over 800 patients, leveraging a larger database from the CIBMTR registry and we systematically looked at infections in adult patients with multiple myeloma undergoing a homogeneous BCMA CAR T-cell construct called ide-cel. So in over 800 patients from the CIBMTR registry analysis, what we found that infection density, cumulative infection density, was around 29% overall. Viral infections predominated across within the first 100 days, about 14.4%. And to be precise, bacterial infections were about 14.1%. Fungal infections were rare throughout the first 100-day post-CAR T-cell infusion, nearly around 3%. Some of the other key takeaways would be that the infection-related mortality was low, 1.1%. In the first 30 days after CAR T-cell infusion, bacterial infections predominated, but then throughout day plus 30 through day plus 100, viral infections really were predominant. We also identified risk factors for infections and we found that higher grade CRS and higher grade neurotoxicity or ICANS drove infections independently in multivariable analysis as well as a prior history of infection also led to infection post CAR T-cell infusion. Lastly, we also looked at whether these infections conferred any impact on survival. So we looked at overall, we did landmark analyses at day 100. So infections developing within the first 100 days directly impacted overall survival post 100 days after ide-cel infusion to the point that the hazard ratio was about 2.4, 2.5 with two or more infections within 100 days. And then similarly, extramedullary disease, plasma cell leukemia, Karnofsky performance score, sub-standard score also conferred survival impact. One thing that we did note had a survival advantage with a hazard ratio of nearly 0.5 was IVIG replacement after CAR T-cell infusion. So we believe that this work is pivotal in developing a sort of baseline infection risk and incidence and density moving forward in patients with multiple myeloma receiving CAR T-cell therapy. This will lead to risk-adapted guidelines and protocols for infection prevention, preemption, surveillance, mitigation, and management protocols.

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