The following is a summary of the article titled “The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma,” published in the July 2023 issue of Hematology by Rejeski et al.

BCMA-directed CAR T-cell therapy (CAR-T) has changed the treatment landscape for relapsed/refractory (r/r) multiple myeloma. Still, distinct side effects hinder it, which may prolong hospitalization and raise morbidity. Researchers performed a cohort study to assess the CAR-HEMATOTOX (HT) score’s predictive value for toxicity and survival in patients on standard-of-care idecabtagene vicleucel and ciltacabtagene autoleucel.

They analyzed data from 113 r/r multiple myeloma patients treated from 04/2021- 07/2022 across six global CAR-T centers. The HT score was assessed pre-lymphodepletion, considering hematopoietic reserve and baseline inflammation.

The results showed 63 patients had an HT^low score (0–1), while 50 had an HT^high score ( ≥ 2) during lymphodepletion. In comparison to the HT^low group, those with HT^high exhibited extended severe neutropenia (median 9, 3 days, P< 0.001), a higher extreme infection rate (40% vs. 5%, P< 0.001), and more severe ICANS (grade ≥ 3: 16% vs. 0%, P< 0.001). The one-year non-relapse mortality was higher in the HT^high group (13% vs. 2%, P= 0.019), primarily due to fatal infections. HT^low patients had higher response rates based on IMWG criteria (≥ VGPR: 70% vs. 44%, P= 0.01). Conversely, HT^high patients had lower progression-free survival (median 5 vs. 15 months, P< 0.001) and overall survival (median 10.5 months vs. not reached, P< 0.001).

They concluded HT score is essential in managing toxicity and treatment response in BCMA-directed CAR-T-treated multiple myeloma patients, assisting in candidate selection.

Source: jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01465-x