Dr Sborov on CAR T-Cell Therapy–Specific Long-Term Treatment Effects in Myeloma

“We need to be mindful of late neurological and gut toxicities. We monitor for changes that may be associated with facial nerve palsies, neuropathy, Parkinsonism, and significant changes in the gut.”

Douglas W. Sborov, MD, MS, associate professor, Department of Internal Medicine—Division of Hematology and Hematologic Malignancies; director, Hematology Disease Center and Plasma Cell Dyscrasias Program, the University of Utah Huntsman Cancer Institute, discusses treatment follow-up and long-term disease management for patients with multiple myeloma who receive CAR T-cell therapy vs those who receive other myeloma therapies.

The follow-up and long-term management strategies for patients treated with CAR T-cell therapy differ from those receiving standard therapies for myeloma, as CAR T-cell therapy presents unique challenges post-treatment, Sborov begins. Although CAR T-cell therapy offers a treatment-free interval, careful monitoring beyond 30 days post-infusion is essential to detect any signs of disease progression, he reports, citing potential early signs of relapse or disease activity.

A significant aspect of post-CAR T-cell therapy management involves managing prolonged cytopenias that often result from the lymphodepleting chemotherapy given prior to infusion, Sborov continues. Patients experiencing extended low blood counts may benefit from interventions, though a stem cell boost may be necessary for severe cases, according to Sborov. Close attention to blood cell count recovery is crucial for supporting immune function and preventing complications, he emphasizes.

Infection monitoring and prevention are vital components of long-term adverse effect (AE)management for patients who have received CAR T-cell therapy, Sborov expands, nothing that patients typically receive antiviral prophylaxis and pneumocystis jirovecii pneumonia prophylaxis until their CD4 levels become safe. Early intervention for bacterial infections is also prioritized, he reports. Immunoglobulin-G levels are regularly assessed, with intravenous immunoglobulin provided as necessary to support immune health, especially in those with recurrent infections, he notes.

Finally, following CAR T-cell therapy, patients are monitored for delayed toxicities, which may include neurological or gastrointestinal (GI) AEs, he states. Specific symptoms to watch for include facial nerve palsies, neuropathy, Parkinsonism, and significant GI changes, he concludes.