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CAR-T, Bispecifics for EMD Myeloma?
Which MM therapy, CAR-T or Bispecifics, is more effective for extramedullary (EMD) disease? EMD that appears after your initial treatment?
“Extramedullary myeloma (EMM) is defined by the presence of plasma cells (PCs) outside the bone marrow in a patient with multiple myeloma (MM).
The incidence is about 3-5% in newly diagnosed MM patients, but has been reported in up to 20% patients in the relapsed MM setting.
What Is Extramedullary Disease in Myeloma? | Understanding & Treatment Explained
According to the research linked below, CAR-T cell therapy is more effective when it comes to managing EMD. Further, the trial below involved heavily treated MM patients- “5-7 prior lines of therapy.”
Do you have EMD? Did you have EMD and have tried, unsuccessfully, to get rid of your EMD?
I am a long-term MM survivor. I would like to hear about your experience. Email me at David.PeopleBeatingCancer@gmail.com with your EMD experiences.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Activity of CAR-T cells and bispecific antibodies in multiple myeloma with extramedullary involvement
Abstract
Extramedullary multiple myeloma (EMD) is associated with:
- low response rates,
- short progression-free survival,
- and poor prognosis.
CAR T cells and bispecific antibodies (bsABs) have shown efficacy in relapsed myeloma, but it remains uncertain whether one T cell redirection strategy should be preferred.
We retrospectively analyzed 80 patients with EMD not adjacent to the bone treated with ide-cel, cilta-cel, teclistamab, or talquetamab at three academic centers in Germany. All patients were heavily pretreated, and a high-risk cytogenetic profile was prevalent in >41% of patients.
All cohorts had a median of 5 to 7 prior lines of therapy. The vast majority of patients receiving cilta-cel, ide-cel, or teclistamab were BCMA-naive ( >88%).
Response rates after CAR T cell infusion were significantly higher (100% with cilta-cel, 82% with ide-cel) than with bsABs (29% for talquetamab, 36% for teclistamab).
Complete resolution of EMD was more frequent after CAR T cell therapies (50% and 41%) than after bsABs (16% and 14%).
With a median follow-up of 12.2 months, median (m)PFS was not reached in patients that had received cilta-cel; mPFS was 7.3 months after ide-cel and significantly longer for both CAR T products compared to talquetamab or teclistamab (mPFS 4.0 and 2.6 months).
Effective debulking therapy prolonged remissions after CAR T cell infusion compared to no debulking or no response to debulking. Visceral and soft tissue manifestations responded significantly less frequently than EMD in other locations. With significantly higher response rates, deeper remissions, and longer mPFS, our retrospective data suggest CAR T cells may provide a meaningful benefit in EMD…
CAR-T or bispecifics for EMD Myeloma? CAR-T or bispecifics for EMD Myeloma?