Clinical Outcomes After Idecabtagene Vicleucel in Older Patients With Multiple Myeloma: A Multicenter Real-World Experience

Authors

Nilesh M Kalariya
Michelle A T Hildebrandt
Doris K Hansen
Surbhi Sidana
Jack Khouri
Christopher J Ferreri
William N Doyle
Omar Castaneda-Puglianini
Ciara L Freeman
Vanna Hovanky
Hitomi Hosoya
Leyla O Shune
Krina K Patel

Publication Date

9-10-2024

Journal

Blood Advances

Abstract

The safety and efficacy of chimeric antigen receptor T-cell therapy is not well described in older patients, a population that has higher frailty and comorbidities. In this multicenter retrospective study, we evaluated clinical outcomes along with frailty and geriatric characteristics such as comorbidities, polypharmacy, falls, neuropathy, organ dysfunction, and performance status in younger (aged < 65 years) vs older (aged ≥65 years) patients who received commercial idecabtagene vicleucel (ide-cel). A total of 156 patients (n = 75, aged ≥65 years) were infused with ide-cel by data cutoff. In older patients (median age: 69 years; range, 65-83; 66.7% frail; 77.3% did not meet KarMMa eligibility criteria), with a median follow-up duration of 14.2 months, best overall response rate (ORR) was 86.7%, which was comparable with pivotal KarMMa study results (ORR: 73%). Median progression-free survival and overall survival in older patients were 9.1 months and 26.5 months, respectively. Grade ≥3 cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome were observed in 1% and 4% of older patients, respectively. Compared with younger patients, the older patients had significantly higher prevalence of frailty, geriatric characteristics such as polypharmacy (≥5 drugs; 97%), ≥4 comorbidities (69%), and organ dysfunction (35%; P < .05). The safety and efficacy of ide-cel therapy were similar in younger and older patients. Frailty and geriatric characteristics such as polypharmacy, comorbidities, and organ dysfunction in older patients did not confer an inferior overall outcome.

Keywords

Humans, Aged, Male, Aged, 80 and over, Female, Multiple Myeloma, Treatment Outcome, Retrospective Studies, Biological Products, Middle Aged, Immunotherapy, Adoptive, Receptors, Chimeric Antigen, Age Factors

DOI

10.1182/bloodadvances.2024013540

PMID

39042903

PMCID

PMC11402173

PubMedCentral® Posted Date

7-25-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes