Comparison of Standard-of-Care Idecabtagene Vicleucel and Ciltacabtagene Autoleucel in Relapsed/Refractory Multiple Myeloma
Abstract
PURPOSE Idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), two B-cell maturation antigen–directed chimeric antigen receptor (CAR) T-cell therapies have demonstrated remarkable efficacy in relapsed/refractory multiple myeloma (RRMM). We compare safety, efficacy, and survival among patients with RRMM treated with standard-of-care (SOC) ide-cel or cilta-cel. METHODS Data were from a retrospective chart review of patients with RRMM leukapheresed by December 31, 2022, with the intent to receive SOC ide-cel or cilta-cel at 19 institutions. An inverse probability of treatment weighting (IPTW) approach was used to compare outcomes by therapy type. RESULTS A total of 641 patients were leukapheresed by December 31, 2022, with ide-cel (n = 386) and cilta-cel (n = 255). Five hundred eighty-six patients were infused (n = 350 for ide-cel; n = 236 for cilta-cel) with a median follow-up of 12.6 and 13.0 months for ide-cel and cilta-cel, respectively. After IPTW, patient characteristics were well balanced. Cilta-cel was associated with higher likelihood of grade ≥3 cytokine release syndrome (CRS; odds ratio [OR], 6.80 [95% CI, 2.28 to 20.33]), infections (OR, 2.03 [95% CI, 1.41 to 2.92]), second primary malignancies (OR, 1.77 [95% CI, 0.89 to 3.56]), and delayed neurotoxicity (OR, 20.07 [95% CI, 4.46 to 90.20]). Cilta-cel was also associated with better treatment responses (≥complete response: OR, 2.42 [95% CI, 1.63 to 3.60]), longer progression-free survival (hazard ratio [HR], 0.48 [95% CI, 0.36 to 0.63]), and longer overall survival (HR, 0.67 [95% CI, 0.46 to 0.97]). No associations were observed between therapy type and immune effector cell–associated neurotoxicity syndrome, any CRS, severe cytopenia at days 30 and 90, or nonrelapse mortality. We observed consistent findings when repeating the analyses restricting the ide-cel cohort to patients infused during the same time period as Food and Drug Administration approval for cilta-cel (≥March 2022). CONCLUSION Cilta-cel demonstrated superior efficacy and survival, with higher incidence of certain toxicities, compared with ide-cel.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (52)
Doris K. Hansen
1Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
Lauren C. Peres
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
Danai Dima
Fred Hutchinson Cancer Center, Seattle, Washington, United States
Alicia Richards
1H. Lee Moffitt Cancer Center and Research Institute, Tampa, United States
Leyla Shune
Aimaz Afrough
Myeloma, Waldenstrom’s, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center (A.A.), University of Texas Southwestern Medical Center, Dallas, TX.
Shonali Midha
13Dana-Farber Cancer Institute, Boston, United States
Binod Dhakal
2Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
Mehmet H. Kocoglu
Shebli Atrash
Levine Cancer Institute–Atrium Health, Charlotte, NC
Christopher Ferreri
7Atrium Health Levine Cancer Institute, Charlotte, United States
Omar Castaneda
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
James A. Davis
13Division of Hematology-Oncology, Medical University of South Carolina, Charleston, SC
Evguenia Bhurtel
1The University of Kansas Cancer Center, Kansas City, United States
Joseph McGuirk
2The Mikael Rayaan Foundation Global Research Training Institute (MRF GRTI), Kansas City, United States
Charlotte Wagner
Radhika Bansal
4Division of Hematology, Mayo Clinic, Rochester, MN
Patrick Costello
9Division of Hematology, Dana-Farber Cancer Institute, Boston, MA
Kinaya Smith
4Medical College of Wisconsin, Milwaukee, United States
Alex Lieberman-Cribbin
12Icahn School of Medicine at Mount Sinai, New York, United States
Gabriel De Avila
H Lee Moffitt Cancer Center, Tampa, Florida, United States
Sneha Purvey
16Virginia Commonwealth University, Richmond, United States
Hitomi Hosoya
Lekha Mikkilineni
Stanford University School of Medicine, Palo Alto, California, United States
Laura B. Oswald
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Gurbakhash Kaur
Oren Pasvolsky
The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Mahmoud Gaballa
4The University of Texas MD Anderson Cancer Center, Houston, United States
Megan M. Herr
Roswell Park Comprehensive Cancer Center, Buffalo, NY
Peter Forsberg
7Colorado Blood Cancer Institute, Hematology, Denver, United States
Murali Janakiram
10City of Hope, Duarte, United States
Myo Htut
City of Hope, Duarte, California, United States
Sireesha Asoori Maringanti
UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA
Nilesh Kalariya
4The University of Texas MD Anderson Cancer Center, Houston, United States
Hamza Hashmi
Memorial Sloan Kettering Cancer Center, New York
Ran Reshef
13Division of Hematology/Oncology, Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY
Douglas W. Sborov
5Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
Omar Nadeem
Faiz Anwer
Cleveland Clinic Foundation, Cleveland, Ohio, United States
Jack Khouri
1Cleveland Clinic Foundation, Department of Hematology and Medical Oncology, Cleveland, United States
Shahzad Raza
Taussig Cancer Institute, Cleveland Clinic, Cleveland
Djordje Atanackovic
Melissa Alsina
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
Ciara L. Freeman
7Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Frederick L. Locke
Peter Voorhees
Department of Materials Science and Engineering
Larry D. Anderson
1Myeloma, Waldenstrom’s, and Amyloidosis Program, Section of Hematologic Malignancies and Cellular Therapy, Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
Shambavi Richard
Icahn School of Medicine at Mount Sinai, New York
Thomas Martin
16Department of Hematology, University of California at San Francisco, San Francisco, CA
Yi Lin
Krina K. Patel
The University of Texas, MD Anderson Cancer Center, Houston, Texas, United States
Surbhi Sidana
Stanford University School of Medicine, Palo Alto, CA