Early cytopenias and infections after standard of care idecabtagene vicleucel in relapsed or refractory multiple myeloma.

Abstract

Idecabtagene vicleucel (ide-cel) was FDA-approved in March 2021 for the treatment of relapsed/refractory multiple myeloma after 4 lines of therapy. On the KarMMa trial, grade ≥ 3 cytopenias and infections were common. We sought to characterize cytopenias and infections within 100 days after ide-cel in the standard-of-care (SOC) setting. This multi-center retrospective study included 52 patients who received SOC ide-cel; 47 reached day-90 follow-up. Data were censored at day 100. Grade ≥ 3 cytopenia was present among 65% of patients at day 30 and 40% of patients at day 90. Granulocyte colony stimulating factor (G-CSF) was administered to 88%, packed red blood cell transfusions to 63%, platelet transfusions to 42%, thrombopoietin (TPO) agonists to 21%, intravenous immunoglobulin to 13%, and CD34+ stem cell boosts to 8%. At day 100, 19% and 13% of patients had ongoing use of TPO agonists and G-CSF, respectively. Infections occurred in 54% of patients and were grade ≥ 3 in 23%. Earlier infections in the first 30 days were typically bacterial (68%) and severe (50%). Later infections between days 31 and 100 were 50% bacterial and 42% viral; only 13% were grade ≥ 3. On univariate analysis, high pre-CAR-T marrow myeloma burden (≥ 50%), circulating plasma cells at pre-lymphodepletion (LD), and grade ≥ 3 anemia at pre-LD were associated with grade ≥ 3 cytopenia at both days 30 and 90. Longer time from last bridging treatment to LD was the only significant risk factor for infection.

• Authors: Jennifer M Logue, Lauren C Peres, Hamza Hashmi, Christelle M Colin-Leitzinger, Alexandria M Shrewsbury, Hitomi Hosoya, Rebecca M Gonzalez, Christina Copponex, Krista H Kottra, Vanna Hovanky, Bita Sahaf, Sunita Patil, Aleksandr Lazaryan, Michael D Jain, Aliyah Baluch, Olga V Klinkova, Nelli Bejanyan, Rawan G Faramand, Hany Elmariah, Farhad Khimani, Marco L Davila, Asmita Mishra, Brandon J Blue, Ariel F Grajales-Cruz, Omar A Castaneda Puglianini, Hien D Liu, Taiga Nishihori, Ciara L Freeman, Jason B Brayer, Kenneth H Shain, Rachid C Baz, Frederick L Locke, Melissa Alsina, Surbhi Sidana, Doris K Hansen
• Journal: Blood advances (Blood Adv) Vol. 6 Issue 24 Pg. 6109-6119 (12 27 2022) ISSN: 2473-9537 [Electronic] United States
• PMID: 35939783 (Publication Type: Multicenter Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Chemical References

• idecabtagene vicleucel
• Receptors, Chimeric Antigen
• Granulocyte Colony-Stimulating Factor

Topics

• Humans
• Multiple Myeloma (therapy)
• Receptors, Chimeric Antigen
• Retrospective Studies
• Standard of Care
• Granulocyte Colony-Stimulating Factor
• Thrombocytopenia
• Anemia