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Real-World Analysis of Bridging Therapy Before CAR T-Cell Therapy for Resistant Myeloma

By: Julia Fiederlein Cipriano, MS
Posted: Wednesday, August 2, 2023

Aimaz Afrough, MD, of UT Southwestern Medical Center, Dallas, and colleagues conducted a study to evaluate the impact of bridging therapy on the outcomes of patients with relapsed or refractory multiple myeloma who subsequently underwent chimeric antigen receptor (CAR) T-cell therapy with idecabtagene vicleucel. This real-world analysis from the U.S. Myeloma CAR T Consortium, which was presented during the 2023 American Society for Clinical Oncology (ASCO) Annual Meeting (Abstract 8013), revealed prolonged survival outcomes without such intervention.

The investigators identified 214 patients who underwent leukapheresis and CAR T-cell therapy. Prior to infusion, 79% of this population underwent bridging therapy with an alkylator-based regimen, immunomodulatory combination, proteasome inhibitor combination, or Selinexor (a selective inhibitor of nuclear export).

The overall response rate with bridging therapy was 12.0%; response rates did not seem to differ among the subgroups. The incidence and severity of cytokine-release syndrome and immune effector cell–associated neurotoxicity syndrome were comparable with bridging therapy versus without. At 90 days after infusion, cytopenias were not found to significantly differ between patients treated with and without bridging therapy, as well as among the subgroups.

In the 157 response-evaluable patients at day 90, both the complete (41.0% vs. 52.0%) and overall (84.0% vs. 87.5%) response rates did not significantly differ with and without bridging therapy. The median duration of progression-free survival was 8.1 months with bridging therapy versus 11.5 months without. Patients who received an immunomodulatory combination demonstrated prolonged progression-free survival, with a median duration of not reached, significantly outperforming all other subgroups, according to the study authors; a comparable outcome was reported without bridging therapy. The median durations of overall survival were 13.8 months and not reached with and without bridging therapy, respectively. In a subgroup analysis, patients treated with alkylator-based regimens demonstrated a numerically shorter median duration of overall survival. The investigators did not report any significant difference in progression-free and overall survival with respect to responses to bridging therapy.

Disclosure: Dr. Afrough reported no conflicts of interest. For full disclosures of the other study authors, visit

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