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CAR-T after MM relapse 13 months post-ASCT
Hi everyone, looking for some advice on pursuing CAR T after a fairly quick (13 month) relapse of multiple myeloma light chains numbers trending up post stem cell transplant. I’m feeling strong and back to a near-normal life so frustrating to feel like I’m starting another arduous process. Would love any success stories on CAR T in this type of relapse situation or any alternative paths people have succeeded with. Thank you so much!
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@jrbris23, welcome. There are several members I can connect you with who have talked about CAR-T therapy for multiple myeloma like @4health4bonnie @cjj2 @pgollinger @myelomawarrior.
While we wait for them to jump into the discussion, you might be interested in reading this related discussion:
- Starting pre-tests for CAR-T infusion for multiple myeloma https://connect.mayoclinic.org/discussion/car-t-infusion-for-multiple-myeloma/
Jrbris23, I can imagine how frustrating it must be to consider embarking on another arduous journey after already having had a stem cell transplant just over a year ago. Thank goodness CAR-T therapy is now a viable option.
Are you scheduled to start CAR-T or is this something you're still considering?
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1 ReactionAsk about bispecific antibodies therapy. It is approved for multiple myeloma patients...studies show good results...
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2 ReactionsThank you Colleen. It is for my mom who underwent ASCT last March and as of a month ago light chains were trending back up. We have had the first conversation with oncology and transplant surgeon about CAR-T but have a second opinion appt scheduled in two weeks to gather more information. CAR T seems to be the suggested next step but I’m trying to get educated to help advocate for her
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1 ReactionThank you, I will!
@jrbris23, thanks for further details. I'm going to tag @roywalton to bring him into this conversation. He has a lot of information to share about treatment options as he was involved the development and testing of some treatments, including CAR-T and bispecifics.
Your mom is lucky to have you doing that research and advocating for her. How is your mom doing? How are her spirits?
She is feeling pretty defeated particularly around having been very concerned about being immunocompromised for the past year plus. She just completed all her vaccinations so was feeling more comfortable with seeing family and friends again. She is worried that CAR T will lead to further isolation. Also very concerned about side effects.
@roywalton any recent data on CAR T or bispecifics for NDMM for Frontline therapy. We've had two consults, both Myeloma experts recommend ASCT over CAR T or bispecifics.
@tmharbison - For NDMM, frontline therapy typically involves induction with a triplet or quadruplet regimen (e.g., bortezomib, lenalidomide, dexamethasone [VRd] or daratumumab, bortezomib, lenalidomide, dexamethasone [D-VRd]), followed by ASCT for transplant-eligible patients, and maintenance therapy (e.g., lenalidomide). ASCT remains the standard of care for fit, newly diagnosed patients up to age 70–75, as it deepens responses and extends progression-free survival (PFS). However, CAR T-cell therapies and bsAbs, which have transformed relapsed/refractory MM (RRMM), are being investigated for NDMM to potentially replace or complement ASCT, especially for high-risk patients.
Would you like more specific clinical examples and outcomes?
He got the quad. D RVd with a VGR. He is stage 2 with 1Q gain, T 11:14. Myeloma experts recommend ASCT over CAR T because of Parkinsons like symptoms and secondary cancers.
We are waiting on Bone marrow biopsy results and clono seq. Can you send data on genomics/translocation the support CAR T over ASCT.