CAR-Hematotox score proves useful in relapsed/refractory MM

In patients with relapsed/refractory multiple myeloma (MM) receiving BCMA-directed CAR T-cell therapy, high CAR-Hematotox scores (HT-high) were associated with an increased risk for severe haematotoxicity, severe infections, and a reduced progression-free survival (PFS) and overall survival (OS) in this retrospective study. According to the authors, these results suggest that the CAR-Hematotox score can be used to drive risk-adapted management strategies for these patients.

“Prolonged cytopenia and infectious complications substantially contribute to the toxicity burden of CD19-directed CAR T-cell therapy,” explained Dr Kai Rejeski (LMU Munich, Germany). The CAR-Hematotox score was developed to estimate the risk for haematotoxicity, infections, and poor treatment outcomes after CD19-directed CAR T-cell therapy. Whether this tool has utility in patients with relapsed/refractory MM receiving BCMA-directed CAR T-cell therapy had not yet been established. Dr Rejeski and colleagues performed a retrospective analysis on patients with relapsed/refractory MM receiving either ide-cel or cilta-cel to assess the use of the CAR-Hematotox score in this population (n=113) [1].

HT-high scores at baseline were significantly associated with a poor performance status, high disease activity, prior autologous stem cell transplant, poor renal function, and increased bone marrow infiltration. Also, patients with HT-high scores had an increased risk for prolonged neutropenia compared with patients with HT-low scores (mean 9 vs 3 days; P<0.001). Other haematological toxicities were also more common among patients with HT-high scores (see Figure). Furthermore, the rate of severe infections was significantly higher in patients with HT-high scores than in patients with HT-low scores (40% vs 5%; P<0.0001), mostly driven by an increased rate of bacterial infections (34% vs 3%; P<0.0001). Finally, HT-high scores were linked to poorer PFS (median 5.4 vs 14.9 months; P<0.0001) and OS (median 10.5 vs not reached; P<0.0001) outcomes.

Figure: CAR T-mediated haematotoxicity in HT-high and HT-low patients [1]



Hb, hemoglobin; ANC, absolute neutrophil count.

1. Rejeski K, et al. The CAR-Hematotox Score As a Prognostic Model of Toxicity and Response in Patients Receiving BCMA-Directed CAR-T for Relapsed/Refractory Multiple Myeloma. Poster 3343, ASH 64^th Annual Meeting, 10–13 December 2022, New Orleans, LA, USA.

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Posted on 20 February 202318 March 2024