Dr. Sidana on CAR T-cell Therapy in R/R Multiple Myeloma With Renal Impairment

Surbhi Sidana, MD, assistant professor, medicine, Department of Medicine, Division of Blood and Marrow Transplantation & Cellular Therapy, leader, Myeloma Cellular Immunotherapy program, Stanford University School of Medicine, discusses the feasibility of administering idecabtagene vicleucel (ide-cel; Abecma) in patients with relapsed/refractory multiple myeloma with renal impairment.

A retrospective evaluation of real-world outcomes of patients with relapsed/refractory multiple myeloma included 211 patients who received standard-of-care ide-cel across 11 US centers in the US Multiple Myeloma CAR T Consortium, Sidana says. Of these patients, 28 had renal impairment, defined as a creatinine clearance of less than 50 mL/min at the time of CAR T-cell infusion, and 11 had severe renal impairment, defined as a creatinine clearance of less than 30 mL/min or being on dialysis at the time of CAR T-cell infusion, Sidana explains.

Adjusting the lymphodepletion doses is important in patients with renal impairment who receive fludarabine, Sidana notes. Although there was no dose reduction mandate since this was a retrospective analysis, 82% of patients with renal impairment received reduced doses of fludarabine, and 74% had over a 20% dose reduction, Sidana says.

Safety data regarding the rate and severity of cytokine release syndrome and neurotoxicity were similar between the patients with renal impairment and those with normal renal function, Sidana explains. Patients with renal impairment tended to have longer hospital stays and higher rates of grade 3 or higher cytopenias at day 30, but these rates became more similar between the 2 groups by day 90, Sidana notes.

Importantly, patients with renal impairment who received ide-cel also benefitted from this treatment, Sidana emphasizes. The overall response rates and median progression-free survival were comparable between the 2 groups, at 96% and 6.5 months, respectively, in patients with renal impairment vs 83% and 8.1 months, respectively, in those without renal impairment, Sidana says. Additionally, there were no differences in non-relapse mortality between the 2 groups, Sidana notes.

When assessing whether renal function changed over time in patients who received ide-cel, the investigators found that ide-cel did not make renal function worse in patients with renal impairment, and from baseline to day 30, no new patients with renal impairment needed dialysis, Sidana highlights.

It is feasible for patients with relapsed/refractory multiple myeloma with renal impairment to receive BCMA-directed CAR T-cell therapy, specifically ide-cel, Sidana concludes.