Model Predicts Outcomes After BCMA CAR-T in Patients With RRMM

Researchers have created a model that incorporates disease-, treatment-, and inflammation-related variables to predict outcomes after anti–B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR-T) therapy in patients with relapsed/refractory multiple myeloma (RRMM), according to a study published in the Journal of Clinical Oncology.

“The MyCARe [Myeloma CAR-T Relapse] model predicts response and survival after anti–BCMA CAR-T, regardless of the region, compound, penta-refractory status, and salvage therapy,” the study authors wrote.

The model was developed using results from a retrospective observational study of patients with RRMM who underwent BCMA CAR-T therapy. The study included 136 patients in Europe and 133 patients in the US.

The overall rate of response was 87%, with similar outcomes observed between cohorts. Rates of complete response were 48% in the European cohort and 49% in the US cohort.

The median time to relapse was 5 months. Relapse within 5 months from BCMA CAR-T infusion was associated with poor survival in both cohorts. Among patients who experienced early relapse, the 12-month overall survival rates were 30% in the European cohort and 14% in the US cohort.

Independent predictors of early relapse or progression included the presence of extramedullary disease or plasma cell leukemia, lenalidomide-refractoriness, high-risk cytogenetics, and increased ferritin at the time of lymphodepletion. Researchers assigned 1 point for each factor to create the MyCARe model. Scores of 0 to 1 indicated a low risk of early relapse or progression, scores of 2 to 3 signaled intermediate risk, and scores of 4 communicated high risk.

The model effectively differentiated patient groups, the researchers reported. In the European training cohort, MyCARe showed a 5-month relapse incidence of 7% for the low-risk group, 27% for the intermediate-risk group, and 53% for the high-risk group. In the US validation cohort, the 5-month relapse incidence was 9% for the low-risk group, 21% for the intermediate-risk group, and 56% for the high-risk group.

“MyCARe is based on real-life data helping to identify patients with the highest likelihood of benefiting from BCMA-directed CAR-T cell therapy, thereby providing a tool for optimal patient selection,” wrote Suzanne Lentzsch, MD, PhD, associate editor of the journal.

Reference

Gagelmann N, Dima D, Merz M, et al. Development and validation of a prediction model of outcome after B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in relapsed/refractory multiple myeloma. J Clin Oncol. 2024;42(14):1665-1675. doi:10.1200/JCO.23.02232