Extramedullary disease is associated with severe toxicities following B-cell maturation antigen CAR T-cell therapy in multiple myeloma

Extramedullary disease (EMD) in multiple myeloma (MM) is associated with poor outcomes following B-cell maturation antigen (BCMA)-targeted CAR-T therapy, yet its impact on treatment-related toxicity remains unclear. This study evaluates the impact of active EMD on toxicity, efficacy, and survival i...

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Main Authors: Andrew J. Portuguese, Emily C. Liang, Jennifer J. Huang, Yein Jeon, Danai Dima, Rahul Banerjee, Mary Kwok, Kara I. Cicero, Alexandre V. Hirayama, Ryan Basom, Christy Khouderchah, Mazyar Shadman, Lawrence Fong, Andrew J. Cowan, Jordan Gauthier
Format: Article
Language:English
Published: Ferrata Storti Foundation 2025-06-01
Series:Haematologica
Online Access:https://haematologica.org/article/view/12122
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Summary:Extramedullary disease (EMD) in multiple myeloma (MM) is associated with poor outcomes following B-cell maturation antigen (BCMA)-targeted CAR-T therapy, yet its impact on treatment-related toxicity remains unclear. This study evaluates the impact of active EMD on toxicity, efficacy, and survival in patients with MM treated with idecabtagene vicleucel (ide-cel) or ciltacabtagene autoleucel (cilta-cel). We conducted a retrospective cohort study of all patients with MM who received ide-cel (n=32) or cilta-cel (n=76) as standard-of-care therapy at our institution from August 2021 to October 2024. EMD was defined as the presence of soft tissue masses in extraosseous locations, and outcomes were compared based on EMD status. Among 108 patients, 26 (24%) had EMD. Patients with EMD experienced higher rates of grade (G)1+ (38% vs. 17%, p=0.022) and G3+ ICANS (19% vs. 1.2%, p=0.003), as well as G1+ (96% vs. 78%, p=0.041) and G3+ eICAHT (31% vs. 0%, p
ISSN:0390-6078
1592-8721