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Which is Better? Ida-cel CAR-T or cilta-cel CAR-T
Which is better- Ida-cel CAR-T vs. Cilta-cel CAR-T? “Better” may depend on the MM patient and the study linked below must be broken down.
- Cilta-cel was associated with a higher likelihood of grade ≥3 cytokine release syndrome, infections, second primary malignancies, and delayed neurotoxicity-
- Cilta-cel was also associated with better treatment responses, longer progression-free survival, and longer overall survival-
- Cilta-cel demonstrated superior efficacy and survival, with higher incidence of certain toxicities, compared with ide-cel.
CAR T-Cell Therapy: How Does It Work?
ChatGPT does a thorough job of breaking down the two therapies-
⚖️ Efficacy:
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Cilta-cel (Carvykti):
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ORR: ~97%
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Stringent CR (sCR): ~82.5%
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Median PFS: ~34.9 months (CARTITUDE-1 and CARTITUDE-4 trials)
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Time to response: Fast (~median 1 month)
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Ide-cel (Abecma):
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ORR: ~73%
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sCR: ~33%
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Median PFS: ~8.8 months (KarMMa trial)
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Time to response: ~1 month
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✅ Cilta-cel shows significantly higher response rates and longer PFS in trials, even when accounting for differences in patient populations.
⚠️ Toxicity:
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Cilta-cel:
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Higher rates of neurotoxicity (including movement/neurocognitive adverse events, ~5%)
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CRS: Very common (95%), mostly grade 1–2; grade ≥3 in ~5%
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Longer monitoring period needed post-infusion (up to 100 days)
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Ide-cel:
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CRS: ~85% (mostly grade 1–2); grade ≥3 in ~5%
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Neurotoxicity: Lower incidence compared to cilta-cel (~18%)
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📌 Ide-cel may have a more favorable safety profile, especially in centers less experienced with high-grade neurotoxicity.
⚙️ Mechanistic & Structural Differences:
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Cilta-cel: Contains two BCMA-binding domains (bivalent), potentially accounting for increased efficacy and deeper responses.
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Ide-cel: Single BCMA-binding domain.
🏥 Clinical Use Considerations:
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Cilta-cel may be preferable if:
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The patient is relatively fit and can tolerate intensive monitoring.
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The center has strong CAR-T expertise.
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Maximizing depth and duration of response is key.
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Ide-cel may be better if:
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The patient is frailer or at higher risk of neurotoxicity.
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There’s urgency and quicker product availability (cilta-cel has had manufacturing delays).
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More manageable toxicity is a priority.
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As is often the case with the treatment of MM, induction therapies, chemo in general, the greater the toxicity, the greater the risk of side effects, and the greater the efficacy.
So the answer to “which is better- Ida-cel CAR-T vs. Cilta-cel CAR-T” depends on the MM patient’s age, frailty, treatment goals, etc.
I am a long-term MM survivor. Are you a RR/MM patient considering CAR-T therapy? Email me at David.PeopleBeatingCancer@gmail.com with questions about enhancing your immune system in preparation for CAR-T therapy.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Comparison of Standard-of-Care Idecabtagene Vicleucel and Ciltacabtagene Autoleucel in Relapsed/Refractory Multiple Myeloma
Purpose
Idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), two B-cell maturation antigen–directed chimeric antigen receptor (CAR) T-cell therapies, have demonstrated remarkable efficacy in relapsed/refractory multiple myeloma (RRMM). We compare safety, effectiveness, and survival among patients with RRMM treated with standard-of-care (SOC) ide-cel or cilta-cel.
Methods
Data were from a retrospective chart review of patients with RRMM leukapheresed by December 31, 2022, with the intent to receive SOC ide-cel or cilta-cel at 19 institutions. An inverse probability of treatment weighting (IPTW) approach was used to compare outcomes by therapy type.
Results
A total of 641 patients were leukapheresed by December 31, 2022, with ide-cel (n = 386) and cilta-cel (n = 255).
Five hundred eighty-six patients were infused (n = 350 for ide-cel; n = 236 for cilta-cel) with a median follow-up of 12.6 and 13.0 months for ide-cel and cilta-cel, respectively. After IPTW, patient characteristics were well balanced.
Cilta-cel was associated with higher likelihood of grade ≥3 cytokine release syndrome (CRS; odds ratio [OR], 6.80 [95% CI, 2.28 to 20.33]), infections (OR, 2.03 [95% CI, 1.41 to 2.92]), second primary malignancies (OR, 1.77 [95% CI, 0.89 to 3.56]), and delayed neurotoxicity (OR, 20.07 [95% CI, 4.46 to 90.20]).
Cilta-cel was also associated with better treatment responses (≥complete response: OR, 2.42 [95% CI, 1.63 to 3.60]), longer progression-free survival (hazard ratio [HR], 0.48 [95% CI, 0.36 to 0.63]), and longer overall survival (HR, 0.67 [95% CI, 0.46 to 0.97]).
No associations were observed between therapy type and immune effector cell–associated neurotoxicity syndrome, any CRS, severe cytopenia at days 30 and 90, or nonrelapse mortality.
We observed consistent findings when repeating the analyses, restricting the ide-cel cohort to patients infused during the same time period as Food and Drug Administration approval for cilta-cel (≥March 2022).
Conclusion
Cilta-cel demonstrated superior efficacy and survival, with higher incidence of certain toxicities, compared with ide-cel.