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Publications

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural Epublish 10 citations

PubMed: 38802346 DOI: 10.1038/s41408-024-01048-0

Prognostic impact of corticosteroid and tocilizumab use following chimeric antigen receptor T-cell therapy for multiple myeloma.

Blood Cancer J 14(1):84

Authors: Bruno Almeida Costa, Jessica Flynn, Noriko Nishimura, Sean M Devlin, Tasmin Farzana, Sridevi Rajeeve, David J Chung, Heather J Landau, Oscar B Lahoud, Michael Scordo, Gunjan L Shah, Hani Hassoun, Kylee Maclachlan, Malin Hultcrantz, Neha Korde, Alexander M Lesokhin, Urvi A Shah, Carlyn R Tan, Sergio A Giralt, Saad Z Usmani, Karthik Nath, Sham Mailankody

Affiliations

  • Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
  • Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Department of Medicine, Weill Cornell Medicine, New York, NY, USA.

Abstract

Despite being the mainstay of management for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), there is limited data regarding the impact of tocilizumab (TCZ) and corticosteroids (CCS) on chimeric antigen receptor (CAR) T-cell efficacy in multiple myeloma (MM). The present study aims to evaluate the prognostic impact of these immunosuppressants in recipients of BCMA- or GPRC5D-directed CAR T cells for relapsed/refractory MM. Our retrospective cohort involved patients treated with commercial or investigational autologous CAR T-cell products at a single institution from March 2017-March 2023. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), complete response rate (CRR), and overall survival (OS). In total, 101 patients (91% treated with anti-BCMA CAR T cells and 9% treated with anti-GPRC5D CAR T cells) were analyzed. Within 30 days post-infusion, 34% received CCS and 49% received TCZ for CRS/ICANS management. At a median follow-up of 27.4 months, no significant difference in PFS was observed between CCS and non-CCS groups (log-rank p = 0.35) or between TCZ and non-TCZ groups (log-rank p = 0.69). ORR, CRR, and OS were also comparable between evaluated groups. In our multivariable model, administering CCS with/without TCZ for CRS/ICANS management did not independently influence PFS (HR, 0.74; 95% CI, 0.36-1.51). These findings suggest that, among patients with relapsed/refractory MM, the timely and appropriate use of CCS or TCZ for mitigating immune-mediated toxicities does not appear to impact the antitumor activity and long-term outcomes of CAR T-cell therapy.

MeSH

Adrenal Cortex Hormones, Receptors, Antigen, Cells, Therapeutics, T-Lymphocytes, Disease-Free Survival, Multiple Myeloma, Receptors, Chimeric Antigen, Progression-Free Survival, Car-T Cell

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