Most patients with multiple myeloma experience disease relapse after treatment with a B-cell maturation antigen-targeted therapy (BCMA-TT), and data describing outcomes for patients treated with sequential BCMA-TT are limited. We analyzed clinical outcomes for patients infused with standard-of-care idecabtagene vicleucel, an anti-BCMA chimeric antigen receptor (CAR) T-cell therapy, at 11 US medical centers. A total of 50 patients with prior BCMA-TT exposure (38 antibody-drug conjugate, 7 bispecific, 5 CAR T) and 153 patients with no prior BCMA-TT were infused with ide-cel, with a median follow-up duration of 4.5 and 6.0 months, respectively. Safety outcomes between cohorts were comparable. The prior BCMA-TT cohort had a lower overall response rate (74% versus 88%; p = 0.021), median duration of response (7.4 versus 9.6 months; p = 0.03), and median progression-free survival (3.2 months versus 9.0 months; p = 0.0002) compared to the cohort without prior BCMA-TT. All five patients who received a prior anti-BCMA CAR T responded to ide-cel, and survival outcomes were best for this subgroup. In conclusion, treatment with ide-cel yielded meaningful clinical responses in real-world patients exposed to a prior BCMA-TT, though response rates and durability were suboptimal compared to those not treated with a prior BCMA-TT.
多数多发性骨髓瘤患者在接受B细胞成熟抗原靶向疗法（BCMA-TT）治疗后会出现疾病复发，且关于序贯接受BCMA-TT治疗患者结局的数据有限。我们在美国11家医疗中心分析了接受标准治疗药物伊基奥仑赛（一种靶向BCMA的嵌合抗原受体T细胞疗法）输注患者的临床结局。共50例曾接受BCMA-TT治疗的患者（38例接受抗体药物偶联物治疗，7例接受双特异性抗体治疗，5例接受CAR T治疗）和153例未接受过BCMA-TT治疗的患者接受了伊基奥仑赛输注，中位随访时间分别为4.5个月和6.0个月。两组安全性结局相当。与未接受过BCMA-TT治疗的患者相比，既往接受BCMA-TT治疗的患者总缓解率较低（74%对比88%；p=0.021），中位缓解持续时间较短（7.4个月对比9.6个月；p=0.03），中位无进展生存期较短（3.2个月对比9.0个月；p=0.0002）。所有5例曾接受抗BCMA CAR T治疗的患者均对伊基奥仑赛产生应答，且该亚组的生存结局最佳。总之，在真实世界中，既往接受过BCMA-TT治疗的患者经伊基奥仑赛治疗后获得了有临床意义的应答，但与此前未接受BCMA-TT治疗的患者相比，其缓解率和持续应答时间均未达到最优水平。
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