Study Suggests CAR T-Cell Therapy Safe, Effective After Allo-SCT in Multiple Myeloma


A retrospective analysis of the CARTITUDE-1 trial suggests that patients who have undergone allogeneic stem cell transplant (allo-SCT) prior to receiving chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma experience comparable outcomes to allo-SCT–naïve patients.

Patients with multiple myeloma who have undergone prior allogeneic stem cell transplant (allo-SCT) showed comparable outcomes to those without prior allo-SCT when treated with ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)–directed chimeric antigen receptor (CAR) T-cell therapy, in the phase 1b/2 CARTITUDE-1 trial (NCT03548207), according to a retrospective analysis.1



The findings, published in Clinical Lymphoma, Myeloma, and Leukemia, suggest that cilta-cel may be a feasible treatment option for patients who have undergone allo-SCT in previous lines of therapy for multiple myeloma.

Although autologous stem cell transplant (auto-SCT) using a patient’s own stem cells is the standard of care in multiple myeloma, the role of allo-SCT, which utilizes stem cells from a donor, is not as clearly defined.1,2 The study authors aimed to determine whether prior allo-SCT affects outcomes among patients receiving CAR T-cell therapy for relapsed/refractory (R/R) multiple myeloma because these patients are typically excluded from clinical trials of CAR T-cell therapy.

“In a post–allo-SCT setting, T cells apheresed for manufacturing of the CAR-T product may include an allogeneic donor component, raising a potential concern for exacerbation or restimulation of graft-versus-host disease following infusion of the CAR-T cells,” the authors explained.

In the CARTITUDE-1 study, cilta-cel showed efficacy in heavily pretreated patients with R/R multiple myeloma who had received at least 3 prior lines of therapy. Updated results reported an overall response rate (ORR) of 97.9% (95% CI, 92.7%-99.7%) and a stringent complete response (sCR) rate of 82.5% (95% CI, 73.4%-89.4%) at a median follow-up of 27.7 months in the overall cohort (N = 97). Regarding progression-free survival (PFS) and overall survival (OS), medians were not reached, but the 27-month PFS rate was 54.9% (95% CI, 44.0%-64.6%) and the 27-month OS rate was 70.4% (95% CI, 60.1%-78.6%).3

The retrospective analysis conducted by authors Htut et al compared outcomes among 7 patients who received prior allo-SCT vs 90 patients who had not received allo-SCT prior to CAR T-cell infusion. The prior allo-SCT cohort received a median of 9 (range, 6-14) prior lines of therapy and had a median time since allo-SCT of 5.1 (range, 2.7-6.2) years, and the remaining 90 patients received a median of 5 (range, 3-18) prior lines of therapy.1

At a median follow-up of 27.7 months following treatment, the ORR among those who had received prior allo-SCT was 85.7% (n = 6) and the sCR was 71.4% (n = 5). In the cohort without prior allo-SCT, the ORR was 98.9%. The safety profile was comparable between groups, with 85.7% (n = 6) of patients in the allo-SCT group experiencing cytokine release syndrome (CRS) and 95.6% of those without prior allo-SCT experiencing CRS. Immune effector cell–associated neurotoxicity syndrome occurred in 14.3% and 16.7% of patients in each group, respectively. Two deaths due to adverse events occurred in the prior allo-SCT cohort, with 1 considered treatment related. No cases of GVHD were reported.

While the efficacy and safety were similar between patients with or without prior allo-SCT in CARTITUDE-1, additional studies are needed to confirm the findings and determine the safety and efficacy of CAR T-cell therapy in patients with multiple myeloma who have undergone allo-SCT in prior lines of therapy.


1. Htut M, Dhakal B, Cohen AD, et al. Ciltacabtagene autoleucel in patients with prior allogeneic stem cell transplant in the CARTITUDE-1 study. Clin Lymphoma Myeloma Leuk. Published online August 22, 2023. doi:10.1016/j.clml.2023.08.012

2. Types of stem cell and bone marrow transplants. American Cancer Society. Updated May 4, 2023. Accessed August 24, 2023.

3. Martin T, Usmani SZ, Berdeja JG, et al. Ciltacabtagene autoleucel, an anti-B-cell maturation antigen chimeric antigen receptor T-cell therapy, for relapsed/refractory multiple myeloma: CARTITUDE-1 2-year follow-up. J Clin Oncol. 2023;41(6):1265-1274. doi:10.1200/JCO.22.00842

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