COMMENTARY

Takeaways From ASH 2015: CAR T cell Therapy for Myeloma

Saad Z. Usmani, MD

Disclosures

December 23, 2015

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The chimeric antigen receptor engineered T cells, or CAR T cells, have become a very exciting area of research for hematologic malignancies. The concept is to engineer the T cells for a specific antigen that is more prevalent in a specific disease subtype and then utilize those T cells to induce long-term remissions in patients in combination with certain cytotoxic therapies.

We've seen early data in the CLL [chronic lymphocytic leukemia] setting and the ALL [acute lymphocytic leukemia] setting that have been presented by the University of Pennsylvania group. But, there is more activity in other disease subsets. The most exciting abstract within that category was the B-cell maturation antigen (BCMA) CAR T-cell engineered data presented by colleagues at NCI [the National Cancer Institute]. They reported early experience in 13 patients in an oral presentation at the ASH [American Society of Hematology] 2015 meeting where they saw some robust responses in very refractory myeloma patients.[1]

The median prior [number of] lines of therapy was seven. They showed some index cases of response where patients even with a disease burden as high as more than 90% plasmacytosis on bone marrow went into very good partial responses (VGPRs) and complete responses (CRs). So that therapy is very encouraging and an exciting area of research.

The caveat is that the CAR T-cells do come with some cytokine-release syndrome, so the patients need to be in some sort of robust performance status. This technology, as it moves forward, will try to mitigate some of those side effects to make this therapy more applicable to a larger myeloma patient population.

For now, we will probably have to be selective in the patients that go on clinical trial, and then as we tease out which patients benefit the best and who can tolerate the therapy, this appears to be a very, very promising option for those patients.

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