Dr. O’Donnell on the Ideal Patients for CAR T-Cell Therapies

Betsy O'Donnell, MD, medical oncologist, Multiple Myeloma Disease Center, director of Lifestyle Medicine, Massachusetts General Hospital, discusses the ideal patients for CAR T-cell therapies in multiple myeloma.

Two CAR T-cell therapies are currently approved by the FDA: idecabtagene vicleucel (ide-cel; Abecma) and ciltacabtagene autoleucel (cilta-cel; Carvykti). These treatments can be obtained by patients through referrals to academic centers, O'Donnell says. When considering the ideal patients for these treatments, the FDA label states that patients should have had 4 or more prior lines of therapy to be eligible, O'Donnell says. Based on these guidelines, clinicians should begin considering a referral when a patient begins their third line of therapy, O’Donnell explains. 

Ideal patients should have been exposed to proteasome inhibitors, immunomodulatory drugs, and CD-38 monoclonal antibodies, and patients should be relatively fit, O’Donnell continues. Moreover, patients should have adequate renal function to be considered for CAR T-cell therapy, since they require the administration of cyclophosphamide chemotherapies, O’Donnell says. Because of the time between the collection of T cells from patients and the re-administration, patients need to be able to handle the bridge period prior to treatment, O’Donnell adds.

There is a commitment when undergoing CAR T-cell therapy, so informing patients and making sure they are prepared is a must, O’Donnell concludes.