Ide-cel CAR-T Therapy Shows Durable Benefit in Older Adults With Relapsed Multiple Myeloma
A study of 366 patients found ide-cel CAR-T cell therapy achieved 81.6% overall response rate in patients 70 or older with relapsed/refractory multiple myeloma, with median progression-free survival of 18.9 months versus 5.7 months with standard regimens.
A study randomized 366 patients 2:1 to receive either one ide-cel infusion or a standard regimen for relapsed/refractory multiple myeloma. All patients, regardless of age, had two to four prior lines of therapy. Both groups contained mostly younger patients, with patients 70 or older comprising 19.3% of the ide-cel group and 20.5% of the standard regimen group.
Regardless of age, all patients achieved a higher overall response rate in the ide-cel group compared with the standard regimen group. Among older patients, the ORR was 81.6% (95% CI, 70.8%-92.5%) with ide-cel versus 48.1% (29.3%-67.0%) with standard regimens (P<0.01). Among younger patients, the ORR was 68.8% (95% CI, 62.4%-75.1%) with ide-cel versus 41.0% (31.5%-50.4%) with standard regimens (P<0.0001).
Progression-free survival followed a similar trend. The median PFS for older patients was 18.9 months (95% CI, 12.1-24.5) with ide-cel versus 5.7 months (2.2-12.2) with standard regimens (P<0.01), while the median PFS for younger patients was 12.5 months with ide-cel (95% CI, 11.2-15.4) versus 4.2 months (3.5-5.7) with standard regimens (P<0.0001).
In both treatment groups, the median overall survival was not reached in older patients. Among younger patients, the median OS was longer with ide-cel compared with standard regimens (39.5 months [95% CI, 27.8-not reached] vs 27.9 months [20.6-not reached], respectively).
The researchers found no significant differences in adverse events with ide-cel, including cytokine release syndrome, neurotoxicity, and infections, between the two age groups. Approximately 30% of older patients in the ide-cel group experienced at least one AE, compared with approximately 39.3% of younger patients.
In the ide-cel group, patients younger than 70 had a higher incidence of triple-class refractory disease (66.8% vs 55.1%, respectively) and high-risk cytogenic abnormalities (44.4% vs 32.7%, respectively) compared with patients older than 70.
The observations reinforce the potential for durable benefit with a single ide-cel infusion in a real-world context without additional adverse safety signals, supporting its use across age groups. Analyses of patient-reported quality of life data and other relevant safety endpoints are ongoing.