Earlier Referral Enables Outpatient Care in Multiple Myeloma

Adam D. Cohen, MD, director of Myeloma Immunotherapy and professor of medicine at the Hospital of the University of Pennsylvania, asked whether patients lose the chance to receive CAR T-cell therapy if referral comes too late. Matthew J. Frigault, MD, clinical director of the Cellular Immunotherapy Program at Mass General Brigham Cancer Institute, acknowledged that every center has seen patients who did not reach treatment in time. That problem was more common when manufacturing slots were limited, he said, but waits for slots have largely disappeared.

Manufacturing is also getting faster. Frigault pointed to anitocabtagene autoleucel (anito-cel), an investigational BCMA-directed CAR T-cell therapy evaluated in the phase 2 iMMagine-1 trial (NCT05396885), which has a turnaround time of 14 to 17 days.

The larger point, Frigault explained, is that less heavily pretreated patients experience better outcomes. Patients with lower disease burden and better functional status have shown improved efficacy, fewer toxicities, and lower long-term mortality after CAR T-cell therapy. Earlier treatment also changes the patient experience; his center now gives most ciltacabtagene autoleucel (cilta-cel; Carvykti) infusions in the outpatient setting. Patients with low tumor burden and slowly progressing disease can visit the clinic once a day for about 30 minutes, then go about their day.