Saurabh Zanwar: Impact of Extramedullary Multiple Myeloma on Outcomes with Ide-cel
Saurabh Zanwar, Assistant Professor at Mayo Clinic, shared on X:
“Out now in Journal of Hematology and Oncology:
Impact of Extramedullary Multiple Myeloma on Outcomes with Ide-cel:
Top line results and a brief thread:
Extramedullary disease (EMD) is noted in 2-4% at diagnosis and prevalence increases with advanced disease
Recent clinical trials enrolling heavily pretreated MM demonstrate rates of secondary EMD at 20-30%
https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.8002
Poor outcomes noted for patients with EMD with majority of existing therapies, including Dara.
Tomas Jelinek et al.
https://pubmed.ncbi.nlm.nih.gov/34247197/
EMD is an independent predictor of inferior survival
https://onlinelibrary.wiley.com/doi/10.1002/ajh.27023
We identified 351 patients infused with ide-cel between 2021-2023
- median FU: 18 m
- median time from MM Dx: ~6 yrs
- 24% patients had true EMD
EMD confers a significantly inferior:
D90 ORR (52% vs. 82%)
PFS (5.3 vs. 11.2 m)
OS (14.8 vs. 27 m)
Extramedullary disease ≠ Paraskeletal disease
Nico Gagelmann et al. in NDMM ASCT
https://pubmed.ncbi.nlm.nih.gov/29419433/
And others have showed this since
We note clearly inferior outcomes for EMD in a homogeneously treated cohort. More biologic insights needed and work underway.
Where do patients with EMD progress?
2/3rd: both hematologic and EMD, 1/3rd hematologic only
1/3rd EMD only
Site and number of disease sites did not seem to impact PFS
Radiation to EMD sites prior to infusion seemed to be safe.
Small numbers for any firm conclusions but trend toward better OS
Lack of response to bridging therapy did not seem to impact outcomes
Higher degree of cytopenias noted in EMD
Comparable rates of prior ASCT, BMPC %, LOTs, baseline cytopenias at lymphodepletion, % alkylators in bridging, etc.
?? more inflammatory milieu in EMD contributing to worse cytopenias
”
Read further.
Source: Saurabh Zanwar/X