CT-511 Clinical Characteristics and Response Outcomes in Older Multiple Myeloma Patients Who Received Idecabtagene Vicleucel: A Single Center Study

Abstract

Multiple myeloma (MM) is a disease of older adults with a median age of 69y at the time of diagnosis. Older patients remain at higher risk for poor outcomes due to physical and physiological decline with aging. To study clinical characteristics and outcomes in older MM patients who received CAR-T therapy. Charts were reviewed retrospectively for older (≥65y) MM patients who received ide-cel between 8/30/2021-05/31/2022. Descriptive statistics were used to analyze clinical characteristics such as age, polypharmacy, comorbidities, history of fall, peripheral neuropathy (active or history), and organ dysfunction (active or history; cardiac, pulmonary, neuro, and/or renal) at infusion. Response outcomes were evaluated using IMWG criteria with the best overall response rate (ORR) recorded and compared to KarMMa study results for older patients (≥65y, n=45) (Munshi et al., NEJM 2021; 384:705-716). In 16 patients (median: 70y, range: 65-83y) (75% ineligible for KarMMa trial), the prevalence of polypharmacy (5+ drugs), excessive polypharmacy (10+ drugs), 4+ comorbidities, history of falls, neuropathy, and organ dysfunction was 94%, 56%, 81%, 37%, 62%, and 50% respectively. Ten patients with ≥30 days of follow up were analyzed for response outcomes. With a median follow up duration of 3.2 months, best ORR was 70% (3 sCR, 1 CR, 2 VGPR, 1 PR, 3 SD/MR), which was comparable to KarMMa study results (ORR > 50%, 95% CI). CRS was grade 1-2 and no major adverse events observed. In a subgroup analysis of eight patients (>70y old), the prevalence of the above characteristics was 100%, 87%, 87%, 37%, 62%, and 62% respectively. For six patients with a median follow up of 4.2 months, best ORR was 100% (2 sCR, 1 CR, 2 VGPR, 1 PR), which was better than KarMMa study results (ORR > 50%, 95% CI). In this small group of older patients, the prevalence of polypharmacy, comorbidities, history of falls, and peripheral neuropathy were higher compared to published reports for general and/or oncology older population. Robust responses and no major toxicities were observed in all patients, especially septua & octogenarians, despite their physical and physiological limitations.