Roundtable Roundup: Early CAR T-cell Therapy in Multiple Myeloma

CASE SUMMARY

• A man aged 60 years who was diagnosed 4 years ago with IgG-κ multiple myeloma presented to his oncologist at first relapse.
• Medical history: hypertension controlled with lisinopril
• Patient received previous treatments with the following:
  • Daratumumab (Darzalex), bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone followed by autologous stem cell transplant (ASCT) with lenalidomide maintenance
• He achieved very good partial response (VGPR) post ASCT and converted to complete response on maintenance.
• The patient had disease progression, and his ECOG performance status was 0.
• After discussion, it was decided to refer the patient for CAR T-cell therapy evaluation.

CASE UPDATE

• The patient was started on daratumumab, carfilzomib (Kyprolis), and dexamethasone (DKd), then was referred to the CAR T-cell therapy center, underwent pre–CAR T-cell testing, and obtained insurance authorization for CAR T-cell therapy.
• After completing 2 cycles with partial response, treatment was held for 2 weeks prior to leuka-pheresis for CAR T-cell therapy.
• DKd was resumed for 1 cycle as bridging therapy during manufacturing, with VGPR.
• He received cyclophosphamide plus fludarabine as lymphodepleting chemotherapy.
• Ultimately, he proceeded to ciltacabtagene autoleucel (Carvykti) CAR T-cell infusion and achieved stringent complete response at day 30.