Extramedullary multiple myeloma (EMD) is associated with low response rates, short progression-free survival, and poor prognosis. CAR T cells and bispecific antibodies (bsABs) have shown efficacy in relapsed myeloma, but it remains uncertain whether one T cell redirection strategy should be preferred. We retrospectively analyzed 80 patients with EMD not adjacent to the bone treated with ide-cel, cilta-cel, teclistamab, or talquetamab at three academic centers in Germany. All patients were heavily pretreated, and a high-risk cytogenetic profile was prevalent in >41% of patients. All cohorts had a median of 5 to 7 prior lines of therapy. The vast majority of patients receiving cilta-cel, ide-cel, or teclistamab were BCMA-naive ( >88%). Response rates after CAR T cell infusion were significantly higher (100% with cilta-cel, 82% with ide-cel) than with bsABs (29% for talquetamab, 36% for teclistamab). Complete resolution of EMD was more frequent after CAR T cell therapies (50% and 41%) than after bsABs (16% and 14%). With a median follow-up of 12.2 months, median (m)PFS was not reached in patients that had received cilta-cel; mPFS was 7.3 months after ide-cel and significantly longer for both CAR T products compared to talquetamab or teclistamab (mPFS 4.0 and 2.6 months). Effective debulking therapy prolonged remissions after CAR T cell infusion compared to no debulking or no response to debulking. Visceral and soft tissue manifestations responded significantly less frequently than EMD in other locations. With significantly higher response rates, deeper remissions, and longer mPFS, our retrospective data suggest CAR T cells may provide a meaningful benefit in EMD.
髓外多发性骨髓瘤（EMD）与低缓解率、较短的无进展生存期及不良预后相关。CAR T细胞和双特异性抗体（bsABs）在复发骨髓瘤治疗中已显示出疗效，但何种T细胞重定向策略更优仍不确定。我们在德国三家学术中心回顾性分析了80例接受ide-cel、cilta-cel、teclistamab或talquetamab治疗的非邻近骨性EMD患者。所有患者均经过深度前期治疗，超过41%的患者存在高危细胞遗传学特征。所有队列既往治疗线数的中位数为5-7种。接受cilta-cel、ide-cel或teclistamab治疗的患者绝大多数为BCMA初治（>88%）。CAR T细胞输注后的缓解率显著高于双特异性抗体（cilta-cel为100%，ide-cel为82%；talquetamab为29%，teclistamab为36%）。CAR T细胞治疗后EMD完全消退的比例更高（50%和41%），而双特异性抗体治疗后较低（16%和14%）。中位随访12.2个月后，接受cilta-cel治疗患者的中位无进展生存期未达到；ide-cel组为7.3个月，两种CAR T产品的无进展生存期均显著长于talquetamab或teclistamab组（分别为4.0个月和2.6个月）。与未接受减瘤治疗或对减瘤治疗无应答者相比，有效的减瘤治疗可延长CAR T细胞输注后的缓解持续时间。内脏和软组织病灶的缓解频率显著低于其他部位的EMD病灶。基于显著更高的缓解率、更深的缓解程度及更长的无进展生存期，我们的回顾性数据表明CAR T细胞可能为EMD患者带来具有临床意义的获益。
肿瘤(癌症)患者之家