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Prashant Kapoor, MD, FACP


Can a Novel Scoring System Predict Outcomes With CAR T-Cell Therapy for Myeloma?

By: Joshua D. Madera, MD
Posted: Thursday, October 12, 2023

Because of the complex treatment-related adverse effects associated with B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory multiple myeloma, the CAR-HEMATOTOX (CAR-HT) scoring system was designed to determine clinical outcomes in this clinical scenario, according to a study published in the Journal of Hematology & Oncology. The CAR-HT scoring system has prognostic utility for patients and may help predict those most suitable for CAR T-cell therapy and how to mitigate treatment-related adverse effects, explained Kai Rejeski, MD, of LMU University Hospital, Munich, and colleagues.

A total of 113 patients with relapsed or refractory multiple myeloma were analyzed retrospectively. All were receiving CAR T-cell therapy at one of six CAR T-cell international *treatment centers. CAR-HT scores were calculated for all patients and were stratified based on whether they were HT-low (n = 63) or HT-high (n = 50). The score, which was determined before lymphodepletion, comprises five markers of hematotoxicity: platelet count, absolute neutrophil count, hemoglobin level, C-reactive protein, and ferritin level.

Patients with HT-high scores were found to have significantly prolonged severe neutropenia (9 days) compared with patients with HT-low scores (3 days). This same trend was observed for severe infection rate (40% vs. 5%, respectively) and severe immune effector cell–associated neurotoxicity syndrome (16% vs. 0%, respectively). Furthermore, the rate of relapse mortality at the 1-year interval was increased for patients with HT-high scores (13%) compared with patients with HT-low scores (2%). This relapse was mostly attributable to fatal infections. Moreover, patients with HT-high scores had a decreased overall survival (10.5 months) and inferior progression-free survival (5 months) compared with their counterparts.

Disclosure: For full disclosures of the study authors, visit

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