CAR-T therapy for multiple myeloma was associated with an 11% (95% CI: 7-19%) incidence of MACE at 12 months, which occurred exclusively in patients who developed cytokine release syndrome.
Observational (n=145)
No
Does early use of tocilizumab reduce the development of MACE in adults undergoing CAR-T therapy for multiple myeloma?
In patients undergoing CAR-T therapy for multiple myeloma, MACE occurred in nearly 10% of patients within 1 year and was exclusively seen in those who developed cytokine release syndrome, despite high rates of early tocilizumab administration.
Abstract Chimeric antigen receptor-T cell (CAR-T) therapies are approved for refractory and relapsed multiple myeloma (MM). Patients with MM have high cardiovascular disease burden due to age and cardiotoxic treatments. Retrospective studies in patients who develop severe grades of cytokine release syndrome (CRS) demonstrated a 20-30% major cardiovascular adverse event (MACE) rate. Early use of the interleukin-6 receptor antagonist, tocilizumab, to reverse CRS may lower rates of MACE. This observational study sought to examine the relationship between early use of tocilizumab and the development of MACE. Single-center retrospective chart review of adults undergoing CAR-T therapy for MM between 2017 and 2023. MACE was defined as composite of myocardial injury, heart failure, stroke, arrhythmias and cardiovascular death over a median period of 12 months. The secondary outcomes were progression free survival (PFS) and overall survival (OS). MACE incidence was estimated using the cumulative incidence function with non-cardiovascular death as a competing risk and compared by Gray’s test, and PFS/OS were analyzed using Kaplan–Meier methods with log-rank tests. Of the 145 patients studied, CRS occurred in 120 patients (82%). Of those with CRS, 107 (89%) received tocilizumab within 24 hours. Within 1 year of therapy, 14 patients (9.7%) experienced MACE. Only patients with CRS developed MACE. The incidence of MACE was 8% 95% CI: 5%, 14% at 6 months and 11% 95% CI: 7%, 19% at 12 months. Progression free survival at 12 months was 58% 95% CI: 50%, 68%. PFS and OS did not differ significantly based on incidence on CRS.
Golec et al. (Sat,) conducted a observational in Multiple Myeloma (n=145). Early use of tocilizumab was evaluated on MACE (composite of myocardial injury, heart failure, stroke, arrhythmias and cardiovascular death). CAR-T therapy for multiple myeloma was associated with an 11% (95% CI: 7-19%) incidence of MACE at 12 months, which occurred exclusively in patients who developed cytokine release syndrome.