Key considerations to determine if CAR T-cell therapy is appropriate for a patient with multiple myeloma
| Consideration . | Comments . |
|---|---|
| Indication | • Does the patient meet the label indication or clinical trial eligibility? |
| Kinetics of disease progression | • Is the patent able to come off all therapy, including a 2-week washout, prior to leukapheresis? • Does the patient need alternative therapy prior to CAR T-cell therapy consideration? |
| Immediate therapy prior to leukapheresis | • How would this affect the ability to successfully manufacture CAR T-cells (ie, obtain sufficient numbers of T-cells and expand)? • Recent alkylators, prior BCMA therapies may impact effectiveness of CAR T-cells. |
| Need for bridging | • Does patient need bridging therapy while waiting for CAR T-cell manufacturing? |
| Contraindicated medications | • Immunosuppressants, anticoagulants. • Can these be safely stopped prior to collection and acute treatment phase? |
| No active infection | • Higher risk of complications if patient experiences CRS. |
| Adequate organ function (renal, cardiac, pulmonary, BM) | • Is the patient healthy enough to receive LD chemotherapy? • Does the patient have organ function reserve to tolerate toxicities of CR T-cell therapy, namely CRS and ICANS? |
| Consideration . | Comments . |
|---|---|
| Indication | • Does the patient meet the label indication or clinical trial eligibility? |
| Kinetics of disease progression | • Is the patent able to come off all therapy, including a 2-week washout, prior to leukapheresis? • Does the patient need alternative therapy prior to CAR T-cell therapy consideration? |
| Immediate therapy prior to leukapheresis | • How would this affect the ability to successfully manufacture CAR T-cells (ie, obtain sufficient numbers of T-cells and expand)? • Recent alkylators, prior BCMA therapies may impact effectiveness of CAR T-cells. |
| Need for bridging | • Does patient need bridging therapy while waiting for CAR T-cell manufacturing? |
| Contraindicated medications | • Immunosuppressants, anticoagulants. • Can these be safely stopped prior to collection and acute treatment phase? |
| No active infection | • Higher risk of complications if patient experiences CRS. |
| Adequate organ function (renal, cardiac, pulmonary, BM) | • Is the patient healthy enough to receive LD chemotherapy? • Does the patient have organ function reserve to tolerate toxicities of CR T-cell therapy, namely CRS and ICANS? |
BM, bone marrow; BCMA, B-cell maturation antigen; CART, chimeric antigen receptor T-cell; CR, complete response; CRS, cytokine release syndrome; ICANS, immune effector cell–associated neurotoxicity syndrome; LD, lymphodepletion.