Advancing CAR T-Cell Care in Relapsed/Refractory Multiple Myeloma: Insights from a Collaborative Quality Improvement Initiative

Abstract

Background Multiple myeloma (MM) is most often diagnosed in late stages where the risk of relapse or progression is highest. Treatment of patients with relapsed disease refractory to many available treatment options poses a substantial clinical challenge for providers. Recently approved chimeric antigen receptor (CAR) T-cell therapies have proven efficacious in highly relapsed/refractory MM. Despite CAR T-cell therapy's efficacy, many challenges and barriers to optimal treatment exist in the integration, communication, and care collaboration between centers related to CAR T-cell therapy for MM patients. To improve quality care related to T-cell therapy treatment in MM, we conducted a quality initiative (QI) study focused on evidence-based integration of CAR T-cell therapy, communication, and care coordination between community oncology clinics and regional CAR T-cell therapy performing centers. Methods Building on the design of our prior QI programs (Hussein ASCO 2020), this initiative includes baseline (n = 93) and follow-up provider surveys, and small-group, team-based audit-feedback (AF) sessions. Survey questions were designed to assess knowledge, confidence, and experiences using CAR T-cell therapy in MM treatment. Care teams from each clinic, along with a CAR T-cell expert from the regional center and nationally renowned expert CAR T-cell physician, participated in audit and feedback sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Additional surveys completed before and after the AF sessions will measure changes in participants’ beliefs and confidence in care delivery. Results Provider Surveys: Providers top reported challenges encountered with CAR T-cell therapy include identifying patients eligible for treatment with CAR T-cell therapy (63%), transferring the patient to a CAR T-cell center for infusion (24%), gaining approval from the insurance company for CAR T-cell therapy (23%) and managing the patient post-CAR T-cell therapy (22%). When asked about the level of communication and collaboration between centers, most providers rated very good/excellent (49%) versus good (29%) and poor/fair (22%). Barriers to very good/excellent communication are insufficient sharing of patient information including test results, premedication documents and details of CAR T-cell therapy administration (30%) followed by lack of expertise in CAR T-cell therapy administration among infusion faculty/clinic staff and lack of time for our clinic's staff to communicate with infusion facility staff (figure 1). HCPs reported vastly different frequencies of referring eligible patients for treatment with CAR T-cell therapy, with a combined 36% often or always referring eligible patients and 34% rarely/never initiating a referral. Small Group A/F Sessions: HCPs participating in the small group A/F sessions also reported identifying patients eligible for treatment with CAR T-cell therapy as the biggest challenge regarding treatment with CAR T-cell therapy. Very high/high confidence in identifying eligible patients for CAR T-cell therapy treatment reported by providers increased from 37% to 72%. HCPs also noted increases in their confidence in managing adverse/late effects of CAR T-cell therapy in patients with MM (38% to 63% very high/high confidence). Conclusions Through this QI initiative, clinical teams created and implemented action plans to close gaps in identifying eligible patients, coordinating CAR T-cell therapy referral and approval, and providing counseling and obtaining consent among hematology/oncology team members. Following the initiative, meaningful confidence gains were observed in identifying eligible patients for CAR T-cell therapy and managing adverse/late effects of treatment. Follow-up surveys will assess self-reported practice changes stemming from the action plans. These data underscore clinical practice gaps that can be addressed in future initiatives to support safe, effective, and evidence-based integration of CAR T-cell therapies into MM care to optimize patient outcomes. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from Bristol Myers Squibb, who had no role in the study design, execution, analysis, or reporting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal