Development and Validation of a Prediction Model of Outcome After B-Cell Maturation Antigen-Directed Chimeric Antigen Receptor T-Cell Therapy in Relapsed/Refractory Multiple Myeloma
Menée à partir de données portant sur 269 patients atteints d'un myélome multiple réfractaire ou récidivant traité par lymphocytes CAR-T, idécabtagène ciloleucel ou ciltacabtagène autoleucel, cette étude met en évidence la performance d'un système de score, basé sur des critères clinico-pathologiques (présence d'une maladie extramédullaire ou d'une leucémie plasmocytaire, haut risque cytogénétique, élévation du niveau de ferritine, caractère réfractaire au lénalidomide, haut risque cytogénétique, augmentation de la ferritine au moment de la lymphodéplétion), pour prédire le risque de récidive ou de progression de la maladie
Purpose : Although chimeric antigen receptor T therapy (CAR-T) cells are an established therapy for relapsed/refractory multiple myeloma (RRMM), there are no established models predicting outcome to identify patients who may benefit the most from CAR-T.
Patients and Methods : This is an international retrospective observational study including patients with RRMM infused with currently available commercial or academically produced anti–B-cell maturation antigen (BCMA) CAR-T. We describe characteristics and outcomes in Europe (n = 136) and the United States (n = 133). Independent predictors of relapse/progression built a simple prediction model (Myeloma CAR-T Relapse [MyCARe] model) in the training cohort (Europe), which was externally validated (US cohort) and tested within patient- and treatment-specific subgroups.
Results : The overall response rate was 87% and comparable between both cohorts, and complete responses were seen in 48% (Europe) and 49% (the United States). The median time to relapse was 5 months, and early relapse <5 months from infusion showed poor survival across cohorts, with the 12-month overall survival of 30% (Europe) and 14% (the United States). The presence of extramedullary disease or plasma cell leukemia, lenalidomide-refractoriness, high-risk cytogenetics, and increased ferritin at the time of lymphodepletion were independent predictors of early relapse or progression. Each factor received one point, forming the three-tiered MyCARe model: scores 0-1 (low risk), scores 2-3 (intermediate risk), and a score of 4 (high risk). The MyCARe model was significantly associated with distinct 5-month incidence of relapse/progression (P < .001): 7% for low-risk, 27% for intermediate-risk, and 53% for high-risk groups. The model was validated in the US cohort and maintained prognostic utility for response, survival, and outcomes across subgroups.
Conclusion : Outcomes of patients with RRMM after CAR-T are comparable between Europe and the United States. The MyCARe model may facilitate optimal timing of CAR-T cells in patient-specific subgroups.
Journal of Clinical Oncology , article en libre accès, 2023