Chimeric antigen receptor T-cell (CAR-T) therapy has demonstrated effectiveness and safety in relapsed/refractory multiple myeloma (RRMM), according to a meta-analysis published in the International Journal of Medical Sciences.
RRMM treatments have come a long way and have drastically improved overall survival, but the disease remains incurable. CAR-T therapy has led to good remission rates in B-cell malignancies and has shown promise in MM and RRMM in preclinical trials.
The current analysis included 23 studies totaling 350 patients diagnosed with RRMM and treated with CAR-T therapy.
A total of 77% of patients achieved an overall response (P <.01), and a pooled proportion of 78% of responders achieved measurable residual disease (MRD) negativity. The pooled complete response rate was 37%.
The pooled proportion of relapse based on 8 studies was 38%, and the median progression free survival (PFS) was 8 months.
The included studies used multiple antigen targets. A total of 19 studies used single-target CAR, including 15 with B-cell maturation antigen (BCMA), and 4 studies used dual-target CAR. The single-target BCMA-targeted CAR-T therapy was more effective than non-BCMA-targeted therapy. BCMA-targeted CAR-T had a pooled overall response rate (ORR) of 82% versus the non-BCMA ORR of 43% (P <.05). Single-target CAR-T did not have a significantly different ORR or adverse events rate than dual-target.
Anti-BCMA contained regimens also showed promising efficacy. An anti-BCMA contained regimen had a pooled ORR of 81% compared with a 43% ORR for an anti-BCMA uncontained regimen.
Overall, CAR-T therapy has shown promising results in RRMM. No results of phase 3 randomized trials of CAR-T therapy for RRMM patients have been reported. Limitations of the study included a lack of uniform baseline characteristics for patients. Also, several studies were ongoing, and the authors used preliminary data to draw conclusions in this analysis.
Future research should focus on the cost-effectiveness of this therapy and its effectiveness in particular subgroups.
Yang Q, Li X, Zhang F, Yang Q, Zhou W, Liu J. Efficacy and safety of CAR-T therapy for relapse or refractory multiple myeloma: a systematic review and meta-analysis. Int J Med Sci. 2021;18(8):1786-1797. doi:10.7150/ijms.46811