EHA 2025 | The potential impact of CAR-T therapies on the future role of HSCT in multiple myeloma

Very short. It will probably kill AST in the future. But it will take time. So the first trial challenging transplant with CAR-T is the CARTITUDE-6 trial. It’s fully enrolled, but just recently. But there is a negative primary endpoint, so it can read out faster than when we have to wait for PFS. Cilta-cel, which is the drug, the CAR-T that’s challenging transplant in that study, is a much more efficient drug than transplant. So I have no doubts that it will win on all efficacy outcomes. The problem is that there are certain side effects with cilta-cel that are problematic. There are some Parkinsonism, maybe not so much in the first line, we don’t know yet. There are some T-cell lymphomas, very rare, but it’s first-line patients with a good prognosis. I think what we are mostly waiting for with this data is not the efficacy of win, because it will be there. Is there any signal of tolerance that we cannot tolerate in patients who have such a good prognosis as they do at diagnosis? But most probably the result of this will make cilta-cel take the place of transplant and transplant will disappear. And that will go very slowly because you have to have it reimbursed and that will take time. You have to have the capacity. This is a much larger population than where we use CAR-T today. So it will take a long time and in that time and also before that other CAR-T’s are doing the same thing. So several CAR-T’s are trying to challenge transplant. And some of them are dual targeting, targeting both BCMA and CD38, or BCMA and GPRC5D both exist. So there will be several of these and they are all challenging transplants, or at least three of them are challenging transplants. So I think transplant days are over, but it will linger for a long time.

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