Dr. Kumar on Integrating CAR T-Cell Therapy Into Heavily Pretreated Multiple Myeloma

Shaji K. Kumar, MD, a consultant in the Division of Hematology and a professor of medicine with Mayo Clinic, discusses the integration of CAR T-cell therapy into the treatment paradigm for heavily pretreated multiple myeloma.

On March 26, 2021, the FDA approved idecabtagene vicleucel (ide-cel; Abecma) as the first BCMA-directed CAR T-cell therapy for patients with relapsed/refractory multiple myeloma who progressed on 4 or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and a CD38-directed monoclonal antibody.

For now, ide-cel will likely be reserved as an option for patients with triple-class refractory disease, says Kumar. As such, ide-cel is competing against other FDA-approved agents, such as belantamab mafodotin-blmf (Blenrep), selinexor (Xpovio), and melphalan flufenamide (melflufen; Pepaxto), Kumar explains.

Notably, if given the option, many providers would select CAR T-cell therapy over belantamab mafodotin, selinexor, or melflufen because ide-cel demonstrated a high rate of durable responses in patients with heavily pretreated multiple myeloma, Kumar says. However, like the lymphoma paradigm, the reimbursement protocol for ide-cel will not be fully realized for 1 to 3 more years, which limits the treatment’s utility, concludes Kumar.