Bispecific antibody and CAR-T therapies have emerged as encouraging treatment options for patients with relapsed/refractory myeloma.
Extensive research is being done on their effectiveness and durability with individuals who have received more than four previous lines of treatment.
However, how are high-risk myeloma patients, such as those with extramedullary myeloma reacting to these exciting new therapies? Less research is being done with patients who have extramedullary disease.
Myeloma drugs are great at targeting the bone marrow. However, as myeloma progresses, myeloma cells can lose their adhesion to the bone marrow and travel outside to other parts of the body, becoming extramedullary (or outside the bone marrow disease).
This usually happens after individuals have relapsed several times, which by clinical definition is high risk disease, although there are rare cases of newly diagnosed myeloma being identified as extramedullary This diagnosis creates a more difficult treatment landscape.
At the recent American Society of Hematology meeting, Charan Vegivinti, MD, shared the results of a systematic review and meta-analysis to compare the efficacy of bispecific antibody treatment vs. CAR T for extramedullary disease and high-risk cytogenetics.
This is an exciting analysis, as specific medical data on the effectiveness of immunotherapy treatments for patients with extramedullary disease and high-risk genetics is usually overlooked and not reported on as often as it should be.
In this study, researchers conducted a systematic literature search to identify clinical trials that investigated the use of bispecific antibodies and CAR T therapies when treating relapsed/refractory patients.
The bispecific search utilized 15 studies from the following sources:
The CAR-T search yielded 27 studies from the following sources:
A statistical analysis was completed with tools to assess for statistical differences.
Overall Response Rate (ORR) was reported across 15 studies, covering a study population of 1083 patients. Researchers pooled the statistics from these studies together to give an accurate reflection of how likely extramedullary and high-risk myeloma patients are to respond to the bispecific antibody treatment.
Overall Response Rates (ORR) for Specific Conditions:
Overall Response Rate for the Entire Group:
Subgroup Analysis:
In simpler terms, bispecific antibody treatment has been proven to be generally effective overall, with about two-thirds of patients responding well. The response rates were also specific to the type of disease, with extramedullary disease showing a response rate greater than 48% and high-risk disease showing a response rate of 63%.
Overall Response Rate (ORR) was reported across 27 studies, covering a study population of 1469 patients. Researchers pooled the statistics from these studies together to give an accurate reflection of how likely extramedullary and high-risk myeloma patients are to respond to CAR T-cell therapy treatment.
Overall Response Rates (ORR) for Specific Conditions:
Overall Response Rate for the Entire Group:
Publication Bias:
In simpler terms, the treatment showed a high overall response rate of 86% across all patients. The response rates for specific conditions, such as extramedullary disease and high-risk cytogenetic abnormalities, were both 77%. However, there's a suggestion of potential publication bias in studies related to CAR T cell therapy, indicating caution in interpreting these results due to a possible influence of which studies are published.
Considering both the possible publication bias and the confidence intervals of the pooled statistics, the overall response rate for both the extramedullary and high-risk cytogenetics groups was found to be higher with CAR T-cell therapy than with bispecific antibody therapy.
This systematic review found both bispecific and CAR T therapy to be effective treatment options for relapsed myeloma patients. However, overall survival in the whole cohort, extramedullary disease cohort and high risk cytogenetic cohort were identified to be superior with CAR-T therapy.
The study indicates the difficulty in directly comparing pooled estimates to two different therapies and found no significant difference in extramedullary disease and high-risk cytogenetics between the different types of bispecific antibody treatments.
Progression-free survival has not been reported in the majority of clinical trials and thus was not included in this report.
Better and more clinical, published reporting of extra-medullary responses is needed to measure the full impact of these treatment options on these patient subgroups and to guide the development of strategies.
As a myeloma patient you can use this study to guide your questions and conversation with your specialist as you are making treatment decisions, especially if deciding between CAR-T or bispecific antibody treatments.
Learn more about both bispecific antibody and CAR T treatments in HealthTree University’s Know Your Therapy course.
Would you like to watch ASH 2023 myeloma research interviews from the investigators themselves? Click "ASH 2023" here: HealthTree University Conference Coverage
To read other ASH 2023 articles, click here: HealthTree 2023 ASH Articles
Bispecific antibody and CAR-T therapies have emerged as encouraging treatment options for patients with relapsed/refractory myeloma.
Extensive research is being done on their effectiveness and durability with individuals who have received more than four previous lines of treatment.
However, how are high-risk myeloma patients, such as those with extramedullary myeloma reacting to these exciting new therapies? Less research is being done with patients who have extramedullary disease.
Myeloma drugs are great at targeting the bone marrow. However, as myeloma progresses, myeloma cells can lose their adhesion to the bone marrow and travel outside to other parts of the body, becoming extramedullary (or outside the bone marrow disease).
This usually happens after individuals have relapsed several times, which by clinical definition is high risk disease, although there are rare cases of newly diagnosed myeloma being identified as extramedullary This diagnosis creates a more difficult treatment landscape.
At the recent American Society of Hematology meeting, Charan Vegivinti, MD, shared the results of a systematic review and meta-analysis to compare the efficacy of bispecific antibody treatment vs. CAR T for extramedullary disease and high-risk cytogenetics.
This is an exciting analysis, as specific medical data on the effectiveness of immunotherapy treatments for patients with extramedullary disease and high-risk genetics is usually overlooked and not reported on as often as it should be.
In this study, researchers conducted a systematic literature search to identify clinical trials that investigated the use of bispecific antibodies and CAR T therapies when treating relapsed/refractory patients.
The bispecific search utilized 15 studies from the following sources:
The CAR-T search yielded 27 studies from the following sources:
A statistical analysis was completed with tools to assess for statistical differences.
Overall Response Rate (ORR) was reported across 15 studies, covering a study population of 1083 patients. Researchers pooled the statistics from these studies together to give an accurate reflection of how likely extramedullary and high-risk myeloma patients are to respond to the bispecific antibody treatment.
Overall Response Rates (ORR) for Specific Conditions:
Overall Response Rate for the Entire Group:
Subgroup Analysis:
In simpler terms, bispecific antibody treatment has been proven to be generally effective overall, with about two-thirds of patients responding well. The response rates were also specific to the type of disease, with extramedullary disease showing a response rate greater than 48% and high-risk disease showing a response rate of 63%.
Overall Response Rate (ORR) was reported across 27 studies, covering a study population of 1469 patients. Researchers pooled the statistics from these studies together to give an accurate reflection of how likely extramedullary and high-risk myeloma patients are to respond to CAR T-cell therapy treatment.
Overall Response Rates (ORR) for Specific Conditions:
Overall Response Rate for the Entire Group:
Publication Bias:
In simpler terms, the treatment showed a high overall response rate of 86% across all patients. The response rates for specific conditions, such as extramedullary disease and high-risk cytogenetic abnormalities, were both 77%. However, there's a suggestion of potential publication bias in studies related to CAR T cell therapy, indicating caution in interpreting these results due to a possible influence of which studies are published.
Considering both the possible publication bias and the confidence intervals of the pooled statistics, the overall response rate for both the extramedullary and high-risk cytogenetics groups was found to be higher with CAR T-cell therapy than with bispecific antibody therapy.
This systematic review found both bispecific and CAR T therapy to be effective treatment options for relapsed myeloma patients. However, overall survival in the whole cohort, extramedullary disease cohort and high risk cytogenetic cohort were identified to be superior with CAR-T therapy.
The study indicates the difficulty in directly comparing pooled estimates to two different therapies and found no significant difference in extramedullary disease and high-risk cytogenetics between the different types of bispecific antibody treatments.
Progression-free survival has not been reported in the majority of clinical trials and thus was not included in this report.
Better and more clinical, published reporting of extra-medullary responses is needed to measure the full impact of these treatment options on these patient subgroups and to guide the development of strategies.
As a myeloma patient you can use this study to guide your questions and conversation with your specialist as you are making treatment decisions, especially if deciding between CAR-T or bispecific antibody treatments.
Learn more about both bispecific antibody and CAR T treatments in HealthTree University’s Know Your Therapy course.
Would you like to watch ASH 2023 myeloma research interviews from the investigators themselves? Click "ASH 2023" here: HealthTree University Conference Coverage
To read other ASH 2023 articles, click here: HealthTree 2023 ASH Articles
about the author
Rozalynn Hite
Rozalynn Hite is the HealthTree Coach Director and wife of myeloma patient Richard Hite. Rozalynn is an occupational therapist and mother of three beautiful children. She is passionate about providing support, education, and resources to help others live full and active lives.
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