Dr Jagannath on the Safety Considerations With CAR T-Cell Therapy Multiple Myeloma

Sundar Jagannath, MBBS, director, Center of Excellence for Multiple Myeloma, professor, medicine (hematology and medical oncology), The Tisch Cancer Institute, Mount Sinai, discusses considerations to keep in mind prior to CAR T-cell therapy initiation in the management of multiple myeloma treatment during relapse.

Jagannath begins by stating that key factors to influence therapeutic decisions encompass treatment availability, ongoing clinical trial participation, patient preference, and safety concerns. In early relapse scenarios, an array of effective treatment options can include pomalidomide and investigational agents, he explains, saying that these approaches remain accessible, underscoring that there are other treatment options available in the first-line if CAR T-cell therapy is not available.

Jagannath notes that academic centers afford patients access to evolving clinical trials, fostering continued therapeutic advancement. Patient-centric preferences delineate a spectrum of inclinations, with some favoring CAR T-cell therapy as a last option, seeking alternative approaches, remaining wary of potential adverse effects (AEs) and hospitalization burdens, he explains.

Crucially, the temporal relationship between tumor burden and CAR T-cell administration significantly influences safety outcomes, Jagannath continues. Notably, administering CAR T-cell therapy during a phase of controlled disease burden may relate to a diminished risk of cytokine release syndrome (CRS) and neurotoxicity.

The effectiveness of CAR T-cell therapy in relation to the proportional to tumor burden emphasizes the importance preemptive disease control in relation to mitigating AEs, he expands. Jagannath emphasizes the overarching objective of enhancing patients survival by optimizing CAR T-cell therapy safety and efficacy, particularly in those who can receive the therapy in an earlier line of treatment, leading to an improved life expectancy for all patients with multiple myeloma.

With robust therapeutic options available for both initial and subsequent relapses, judicious timing of CAR T-cell therapy administration represents a strategic avenue to augmenting long-term outcomes in multiple myeloma management, Jagannath concludes.