The study, presented by Dr Deepu Madduri (Mount Sinai Medical Center, USA), examined the investigational CAR T-cell therapy JNJ-4528. These CAR T-cells bind to 2 different epitopes on the B-cell maturation antigen (BCMA). BCMA is almost always overexpressed in multiple myeloma.
The study population was heavily pre-treated, had a median age of 60 years, a median disease duration of 6 years, as well as a median of 5 prior lines of therapy. All of the patients had received 3 standard therapies for myeloma (i.e. protease inhibitor, immunomodulatory agent, and CD38 inhibitor), and all but 2 of the patients had triple-refractory disease. Additionally, 25 of 29 patients had undergone autologous transplantation.
Safety was the primary outcome of the current study, although efficacy was also included in the phase 2 outcomes. Like all CAR T therapies, adverse events were significant. Haematologic toxicity was common, including neutropenia in 93% of patients (all grade ≥3), anaemia in 86% (55% grade ≥3), thrombocytopenia in 86% (69% grade ≥3), leukopenia in 52% (52% grade ≥3), and lymphopenia in 45% (31% grade ≥3). The most common non-haematologic adverse events were increased liver enzymes (AST and ALT), diarrhoea, and upper respiratory tract infection, occurring in 25-30% of patients. Grade ≥3 non-haematologic toxicity was infrequent, consisting of 2 cases of increased AST and 1 each of increased ALT and diarrhoea. Out of 29 patients, 27 developed cytokine release syndrome, which reached grade 3 severity in 1 patient and was associated with 1 death. Immune effector cell-associated neurotoxicity syndrome occurred in 3 patients, including grade ≥3 in 1 patient. Dr Madduri said there were no unexpected treatment-related adverse events, and toxicity in general was manageable.
"We observed early and deep responses in patients, and 27 of 29 patients remained progression free at 6 months of follow-up," Dr Madduri said. "Safety and efficacy results are consistent with a previous study conducted in China. The phase 2 portion of the study is fully enrolled, and phase 2 and 3 studies have been initiated." The treatment just received breakthrough therapy designation from the FDA, she added.
1. Madduri D, et al. Abstract 577, ASH 2019, 7-10 December, Orlando, USA.
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Table of Contents: ASH 2019
Featured articles
Late-Breaking Abstracts
Likely new standard of care: Blinatumomab for children with relapsed B-ALL
Pivotal phase 3 trial in cold agglutinin disease: sutimlimab can stop haemolysis
Oral azacitidine improves overall survival in patients with AML in remission
BCL11A as a novel target in gene therapy for sickle cell disease
Adding daratumumab to carfilzomib/dexamethasone prolongs PFS and OS in R/R MM
Long-term data of ropeginterferon alpha-2b in polycythaemia vera
Anti-CD70 is safe with hypomethylating agents in AML
MRD assessment to guide pre-emptive treatment decisions
Luspatercept effective for myelofibrosis-associated anaemia
Arsenic, ATRA, and ascorbic acid in acute promyelocytic leukaemia maintenance
Updated results ECOG-ACRIN E2906: decitabine maintenance after alloSCT
Sickle Cell Disease
Arginine supplements help against sickle cell disease pain
Abatacept prevents graft-versus-host disease in sickle cell patients after alloSCT
Plenary Scientific Session
HOVON-96: Better outcomes with cyclophosphamide after transplantation
Erythroferrone and skeletal changes associated with thalassaemia
Experimental model for limitations of haematopoietic stem cells propagation
Mosunetuzumab: complete remissions in non-Hodgkin lymphoma
Inclusive Medicine
Socioeconomic disparities and survival in paediatric AML
Oral selinexor/pomalidomide/dexamethasone shows activity in heavily pre-treated multiple myeloma
CAR T-cell therapy successful in older non-Hodgkin’s lymphoma patients
Mild renal impairment in African Americans does not affect OS in AML
ALCYONE: New overall survival results for myeloma
Venous Thromboembolism
Rivaroxaban is safe and effective for paediatric venous thromboembolism
Aspirin plus DOAC is not better than a DOAC alone
20-Year follow-up of imatinib in chronic myeloid leukaemia after failure with interferon
CAR T and Beyond
BCMA-targeted CAR T therapy yields 100% response in relapsed/refractory MM
Anti-BCMA/anti-CD38 in refractory multiple myeloma
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