Treating Patients who Progress Following CAR T in R/R MM
Caitlin Costello, MD, provides clinical insights on best practices for treating patients with relapsed/refractory multiple myeloma who receive early-line CAR T-cell therapy and later relapse.
Case: A 60-Year-Old Woman with Later Relapsed/Refractory Multiple Myeloma
Clinical Presentation:
- A 60-year-old woman who was previously diagnosed 3 years ago with R-ISS stage 2/R2-ISS stage III IgG-lambda multiple myeloma presents to his oncologist after two prior treatment regimens.
- Lives in a rural community
Prior Treatments:
- Patient received previous treatments with:
- D-VRd followed by ASCT with lenalidomide maintenance.
- Elo-Pd
Follow up and Clinical Workup at Relapse:
- Ca 12.5 mg/dL; SCr 2.5 mg/dL
- Hgb 8.2 g/dL; LDH 290 U/L; Albumin 2.8 g/dL
- Beta-2 microglobulin: 6 mg/dL
- BM Biopsy: 65% lambda light chain restricted.
- sIFE, IgG lambda present
- M protein 5.2 g/dL; sFLC kappa 5 mg/dL; sFLC lambda 560 mg/dL
- Lambda/Kappa ratio, 112
- Repeat Imaging:
- PET/CT scan showed no additional lesions.
- ECOG PS 1
- After discussion with his clinical team, the patient begins evaluations for CAR T referral.
- Patient ultimately proceeded to ide-cel CAR T-cell infusuion.
- Achieved stringent CR at day 30.
- Patient ultimately proceeded to ide-cel CAR T-cell infusuion.
Video content above is prompted by the following questions:
- In a clinical scenario in which a patient receives early-line CAR T and later relapses:
- How would you approach treatment sequencing for patients who progress beyond CAR T in early relapse MM?
- For which patients might you consider restarting a quad regimen, post-CAR T?
- At what point in time might you consider bispecific antibodies?
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