Randomized trial evaluates CAR-T cell expansion and neurotoxicity in multiple myeloma, suggesting early alert strategies.
Key Points
To investigate the relationship between CAR-T cell expansion and the occurrence of neurotoxicity in patients with relapsed/refractory multiple myeloma.
Evaluated CAR-T cell kinetics in patients treated with ide-cel or cilta-cel (N=90).
Analyzed absolute lymphocyte count (ALC) as a surrogate biomarker in a multicenter cohort (N=532).
Measured peak CAR-T cell expansion and its correlation with clinical outcomes and toxicities.
Cilta-cel showed median CAR-T cell expansion of 106 cells/uL vs. ide-cel's 49 cells/uL.
Rapid cilta-cel expansion was linked to increased risk of delayed neurotoxicities (DNTs), median peak 1,009 vs. 96 cells/uL.
A peak ALC ≥3000/uL predicted elevated DNT risk with 81% sensitivity and 59% specificity.