https://orcid.org/0000-0003-3288-7614
Key Points
Compared to younger and non-frail patients, older adults and frail patients treated with ide-cel experience comparable efficacy.
Higher rates of ICANS were noted in older and frail patients, but there were no significant differences in treatment-related mortality.
Idecabtagene vicleucel (ide-cel) is an anti-BCMA CAR-T cell therapy approved for patients with relapsed/refractory multiple myeloma (RRMM) after 2 prior lines of therapy. There is limited data on outcomes of CAR T in older adults and frail patients with RRMM. In this study, we utilized data from the Center for International Blood and Marrow Transplantation Registry to describe the safety and efficacy of ide-cel in these clinically important subgroups. An adapted version of the previously described simplified frailty index (SFI) was used to assess frailty. A total of 821 pts were followed for a median of 11.6 months (m, range, 1.1 - 26.7 m). Of these patients, 251 (30.6%) were ≥70 years of age. Older adults had higher rates of immune-effector cell associated neurotoxicity syndrome (ICANS) of any grade (37.1% vs 24.2%, p<0.01), but there were no differences in grade ≥3 ICANS or cytokine release syndrome (CRS, any grade or grade≥3). Older adults had improved progression-free survival (PFS) which remained significant in a multivariable model. There was no significant difference in treatment related mortality (TRM). Frail patients (343/766) had a higher rate of ICANS of any grade (37% versus 21.5%, p<0.01) and clinically significant infections (49.6% vs 40.9%, p=0.02), but there were no significant differences in grade ≥3 ICANS, CRS, response, PFS, overall survival or TRM.In conclusion, older adults and frail patients with RRMM had comparable efficacy to younger and non-frail patients, respectively. These patients were at higher risk of developing ICANS but had no increase in other adverse events.
