CAR T-Cell Therapy for the Management of Multiple Myeloma - Episode 10
Implications for using real-world data to better understand how to use CAR T-cell therapy as treatment for relapsed/refractory multiple myeloma and suggestions on what needs to be analyzed further.
Parameswaran Hari, MD, MRCP: As CAR [chimeric antigen receptor] T-cell therapy has been available for diffuse large B-cell lymphoma and ALL [acute lymphoblastic leukemia] for a while, I can speak to the patterns of change that have happened. I now realize that our referring doctors are good at sending patients early for CAR T referrals. That message has certainly gotten through to physicians treating lymphoma, and patients who have lymphoma. At the sign of early relapse, this is now considered an important and likely curative option, which is the most important point to remember when we talk about lymphoma. Our referrals have moved closer to an earlier referral pattern. In fact, we do get a lot of referrals when the question is whether a patient needs an autologous stem cell transplant or a CAR T cell, which is a welcome change. However, even when you look at the global picture, the number of patients receiving CAR T is only a tiny fraction of the patients with relapsed diffuse large B-cell lymphoma in this country. As such, it remains to be seen whether it is geographic variation, or if it is an inability of patients and centers to get through all the logistics needed.
How the real-world evidence in lymphoma can inform us about multiple myeloma is a tough question. Arguably the population of patients with myeloma is a little older, and the single most important payer in this setting is Medicare or CMS [the Centers for Medicare & Medicare Services] which is one of the biggest logistical challenges facing CAR T centers trying to apply this very effective treatment in patients. The Medicare payment models are changing as of January 2021, and this will have a significant impact. Thankfully, it is trending in the direction of better payment, so that centers do not take a hit or a loss on the patients when they’re trying to give this treatment, which is an important thing. Notably, this is an expensive therapy, and in myeloma, when the therapy is eventually approved by the FDA and marketed, I’m sure it will be an expensive therapy. The message is that despite the expense, if it’s a utilitarian approach and the cost-benefit ratio is good, we need to be applying this therapy. Overall, getting the message to the payers is a big challenge that the myeloma community will have to overcome.