Synapse - Prognostic impact of corticosteroid and tocilizumab use following chimeric antigen receptor T-cell therapy for multiple myeloma

Prognostic impact of corticosteroid and tocilizumab use following chimeric antigen receptor T-cell therapy for multiple myeloma Journal Article

Authors:	Costa, B. A.; Flynn, J.; Nishimura, N.; Devlin, S. M.; Farzana, T.; Rajeeve, S.; Chung, D. J.; Landau, H. J.; Lahoud, O. B.; Scordo, M.; Shah, G. L.; Hassoun, H.; Maclachlan, K.; Hultcrantz, M.; Korde, N.; Lesokhin, A. M.; Shah, U. A.; Tan, C. R.; Giralt, S. A.; Usmani, S. Z.; Nath, K.; Mailankody, S.
Article Title:	Prognostic impact of corticosteroid and tocilizumab use following chimeric antigen receptor T-cell therapy for multiple myeloma
Abstract:	Despite being the mainstay of management for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), there is limited data regarding the impact of tocilizumab (TCZ) and corticosteroids (CCS) on chimeric antigen receptor (CAR) T-cell efficacy in multiple myeloma (MM). The present study aims to evaluate the prognostic impact of these immunosuppressants in recipients of BCMA- or GPRC5D-directed CAR T cells for relapsed/refractory MM. Our retrospective cohort involved patients treated with commercial or investigational autologous CAR T-cell products at a single institution from March 2017-March 2023. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), complete response rate (CRR), and overall survival (OS). In total, 101 patients (91% treated with anti-BCMA CAR T cells and 9% treated with anti-GPRC5D CAR T cells) were analyzed. Within 30 days post-infusion, 34% received CCS and 49% received TCZ for CRS/ICANS management. At a median follow-up of 27.4 months, no significant difference in PFS was observed between CCS and non-CCS groups (log-rank p = 0.35) or between TCZ and non-TCZ groups (log-rank p = 0.69). ORR, CRR, and OS were also comparable between evaluated groups. In our multivariable model, administering CCS with/without TCZ for CRS/ICANS management did not independently influence PFS (HR, 0.74; 95% CI, 0.36-1.51). These findings suggest that, among patients with relapsed/refractory MM, the timely and appropriate use of CCS or TCZ for mitigating immune-mediated toxicities does not appear to impact the antitumor activity and long-term outcomes of CAR T-cell therapy.
Keywords:	apoptosis; single-arm
Journal Title:	Blood Cancer Journal
Volume:	14
ISSN:	2044-5385
Publisher:	Nature Publishing Group
Date Published:	2024-05-27
Start Page:	84
Language:	English
ACCESSION:	WOS:001233354100001
DOI:	10.1038/s41408-024-01048-0
PROVIDER:	wos
PMCID:	PMC11130279
PUBMED:	38802346
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding authors are MSK authors: Karthik Nath, Sham Mailankody -- Source: Wos