How did high-risk myeloma patients fare on the DETERMINATION TRIAL (early vs late autologous stem cell transplantation)?
Patients considered to have high-risk myeloma based on their cytogenetics such as those with the translocation of chromosomes 4 and 14 benefited from early transplant in terms of longer time until disease progression, but patients with a deletion of chromosome 17p did not. Other subgroups (such as those with the translocation of chromosomes 14 and 16) had too few patients to determine their outcome or draw conclusions. Patients with chromosome 1 abnormalities were not a prespecified high risk subgroup at the time of the study design; however, study investigators plan to review the data from those patients in a future analysis. Patients with revised International Staging System (R-ISS) stage I and R-ISS stage II also benefited from early transplant, but patients with R-ISS stage III did not. However, as with the overall population of patients in the study, patients with high-risk disease did not live longer (that is, overall survival was not affected by early transplant). It is suggested that more time is needed to observe the high-risk patient groups to confirm whether early transplant has an impact on overall survival.
What options do patients have once chimeric antigen receptor (CAR) T-cell therapy stops working?
Based on data from the clinical trials of the two, FDA-approved, BCMA-directed CAR T-cell therapies (Abecma and Carvykti), almost all patients respond to treatment and the response lasts for about one year. For those patients who achieve a complete response or who achieve minimal residual disease (MRD) negativity in the first month, response may be longer than one year. Unfortunately, all patients will eventually relapse and it is still unclear as to why. It is possible that CAR T-cells do not persist long in the blood or that the expression of BCMA may decrease (or both). Based on retrospective studies, it has been observed that other BCMA-directed therapies (such as bispecific antibodies) can be used after BCMA-directed CAR T-cell therapy relapse. Very few patients respond to the same CAR T-cell therapy.
What is the latest information on COVID-19?
Myeloma patients still need to be vigilant about the potential for COVID-19 infection. The latest information and recommendations for myeloma patients include:
To learn more about all the myeloma studies presented and highlighted from the 2022 American Society of Clinical Oncology meeting, please view our blog post here.
