Multiple myeloma: CAR T cell therapies
Immunomodulators and CAR T cell therapies appear to change the prospects for the treatment of some blood cancers, a complete response in multiple myeloma.
A new CAR T cell, ide-cel, has given a complete response rate in multiple myeloma. In practice, 45.9% of patients who developed early recurrence, after stem cell transplantation. Also, 74.2% of patients responded poorly to transplantation.
Advances in the treatment of blood cancers continue. In large B- cell lymphoma, the new cell therapy liso-cel gave a 74% complete response in relapsed or refractory disease. Complete responses compared to the standard of care, i.e. immunochemotherapy followed by autologous stem cell transplantation. Survival reached 53% in patients treated with liso-cel compared to 21% with standard of care. The complete response was 74% and 43%, respectively.
There are complete responses of 36.8% in multiple myeloma patients also opening prospects in non-Hodgkin’s lymphoma , with better disease control. An example is iberdomide which has been effective in relapsed or refractory patients. Preliminary results from a study show 32% complete responses. Thanks to the new generation of immunomodulators, new valid treatment scenarios are opening up.
Michele Cavo, Director of the ‘LA Seràgnoli’ Institute of Hematology, IRCCS S. Orsola-Malpighi, University of Bologna and Full Professor of Hematology at the same University, states:
The most advanced and innovative frontier of immunotherapy is represented by therapy with CAR T cells, based on the patient’s lymphocytes genetically modified. Ide-cel is a second generation cell therapy directed against the BCMA antigen (B Cell Maturation Antigen), expressed on the surface of plasma cells. Thanks to this approach, significant results were highlighted in the multicenter phase II KarMMa-2 study in patients with multiple myeloma and early disease progression, i.e. within 18 months of initial treatment including autologous stem cell transplantation. Cell therapy has demonstrated complete and durable responses in a significant proportion of patients, as well as good tolerability.
Advances are also being made in the treatment of myelodysplastic syndromes , where bone marrow cells show impaired maturation. Luspatercept is a drug that relieves the need for transfusions for at least 8 weeks in patients with this kind of syndromes.