Hi, I'm Samir Parekh.
I'm the director of the multiple myeloma program at the Icahn School of Medicine at Mount Sinai in New York.
And, I'm going to speak today about, some exciting developments with Car-T for myeloma patients.
I had a presentation yesterday on the earlier use of cilta-cel, and, its correlation with better immune fitness in patients that have gotten a cilta-cel as part of the Cartitude-4 study.
So this was a study that randomized patients to get cilta-cel after 1 to 3 lines of treatment, that is, after they had relapsed one or 2 or 3 times as compared to earlier studies of cilta-cel, like the Cartitude-1 study where patients had to fail three or more lines and, were much more proteasome inhibitor or velcade and revlimid refractory.
These patients only needed to be refractory to revlimid.
And, what really came out as exciting in this study was that there was an overall survival advantage, as well as a progression free survival advantage.
If you treated patients with Car-T earlier.
This is not a still out there in the community, and patients are getting under standard of care treatment instead of Car-T.
So, we decided to study the bone marrow samples and the peripheral blood of patients that had gotten these treatments to see if we could actually understand why patients were doing better.
And the results were startling.
While doing this, an analysis of both studies breaking up the patients by lines of treatment showed that the patients that got 1 or 2 lines of treatment actually had a much better progression free survival.
In fact, if we look at patients that were treated late, in Cartitude-1, for example, with three and more lines of treatment, their progression free survival was about 35 months.
If they had exactly three lines of treatment, that jumped to 15 months.
And it's not even reached for patients that have gotten less than three lines.
So one, two, three lines are still developing.
Strikingly, looking at their bone marrow, we found and the bone marrow environment actually help the Car-T so there were cells in the bone marrow called myeloid cells that are anti-tumor, and T cells that we know are anti-tumor, that were being activated by the Car-T more in patients and early lines of treatment than in late lines of treatment.
And we also measured a very key feature of T cell fitness, which is how many naive T cells.
These are young T cells that can fight tumor more effectively.
And we found that patients with earlier lines of treatment had more of these.
And in fact, that correlated with progression free survival that even correlated with 1 or 2 lines of treatment.
So it really goes to show that cilta-cel given earlier works better not just clinically works better, but works better by harnessing an immune system better.
And this is something that both patients and doctors really need to understand, because I think there are still patients in the community that, don't get offered cilta-cel.
And education around this is very important.
So I would advise patients to talk to your doctors, talk to Car-T specialists.
If you have seen even one line of myeloma and your disease is coming back, there are very effective treatment options.
Now, and cilta-cel is proving to be a great one.
At least consider it and see if that's an option for you.
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HealthTree • December 23, 2025