Is CAR T-cell therapy being used to treat newly diagnosed multiple myeloma?

This week's Ask Dr. Durie comes from a patient  who has heard that CAR T-cell therapy—the very exciting new immune therapy that has been  evaluated in patients with relapsed/refractory myeloma and two CAR T products have been approved  by the FDA (Food and Drug Administration). So, the question is: have CAR T cells  been used earlier in the disease? The answer to that question is yes. At the  recent ASH meeting in December 2022—held in New Orleans—there was a presentation by Dr.  Juan Du from Sh

anghai, China. She presented the results using a new CAR-T product in  patients with newly diagnosed myeloma—so really a unique new study. She also used a new  product with dual targeting, BCMA and CD19, so a double targeting of the myeloma cell and  using a new manufacturing technique which makes the CAR T cells available within 48 hours.  So really it is a remarkable new development. And so, in this treatment protocol, newly  diagnosed patients—and she started with patients who have high-risk

myeloma—so these  are patients with active myeloma, but with the high-risk features such as abnormal chromosomes,  plasma cell, leukemia, things like that. So, the CAR-T treatment was given to those patients after  initial disease control using Velcade®, Revlimid®, and dex for two cycles or initial two cycles of  therapy, followed by the CAR T-cell infusion. And so, the initial results were remarkably  good. All the patients have had an overall response rate and not only that, but  all the patie

nts have also achieved an MRD-negative status. All the patients have  had deep, deep responses at this point. So, a remarkable, strong benefit using these CAR T cells as an early treatment in  patients with newly diagnosed myeloma. The CAR T-cell therapy has been well tolerated  with only very low cytokine release syndrome, what we call CRS. So that is very, very promising. And so, the BOTTOM LINE is that this first study,  looking at the use of CAR T cells earlier in the disease course, in this

case, for newly diagnosed  patients is extremely promising. And so, I think everyone is quite excited to see the results with  this rapid production of the cells using a new lab technique and with the new dual targeting CAR T  cells, and it looks like this protocol can lead to many more evaluating what looks like can be a  very successful approach to early disease control.