5 Myths vs Facts About CAR T for Myeloma
Moffitt is an established leader in the field of bone marrow transplantation (BMT) and chimeric antigen receptor or CAR T cell therapy. Our Bone Marrow Transplant and Cellular Immunotherapy Program individually assesses each patient’s condition, and our multispecialty team recommends the most appropriate option, often offering transplantation and CAR T services for many patients with potential contraindications. Dr. Ciara Freeman addresses some misconceptions we frequently hear:
Myth #1: Autologous transplantation is only indicated in younger patients.
Although the bulk of evidence for transplant is in patients under the age of 65, age alone is not a limiting factor for autologous transplantation. At Moffitt, we have developed a comprehensive screening program for all patients aged 65 years and older referred for complex immunotherapies, with the aim of optimizing them for the best treatment upfront. We have shown equivalent outcomes for patients that received autologous transplantation at our center above the age of 70 to their younger counterparts and therefore have no strict chronological age limit, as long as they are in good enough physical condition to tolerate the procedure.
Myth #2: My patient has only had 2-3 prior lines of therapy therefore doesn’t meet the criteria for CAR T therapy yet
While this is true, we have several trials at Moffitt open for those who have progressed after fewer lines of therapy which patients can benefit from right now. Also, when we identify patients earlier in the disease course, we can identify when they are suitable for commercial CAR T cell therapy at the first sign of progression after that 4th line, getting them to their CAR T faster and ideally with a lower burden of disease.
Myth #3: My patient is progressing now and cannot wait for CAR T
Moffitt has treated more patients with commercial products than any other center for myeloma and as manufacturing capabilities increase, so too does our capacity. As a result, our waitlist is getting much shorter and for those in urgent need, we have been able to prioritize them for slots, increasingly within just a few weeks of the initial consultation. We also have several clinical trials open with active and available slots for appropriate patients. For those seen, we can also then provide input on the optimal bridging regimen, including in silico testing of plasma cells against a huge array of agents to select the combination that will afford the optimal disease control while awaiting CAR T, with a rapid turnaround time.
Myth #4: Transplant and CAR T therapy are too expensive for the majority of patients
Many insurance plans, including Medicare and Medicaid, cover transplant and CAR T therapy. Additionally, there are financial assistance programs available to help patients with the costs of treatment. In addition, we have several clinical trials open at present that will also support enrolled participants. At Moffitt, we work closely with patients and their insurance providers to ensure that they have access to therapy at every stage of their disease course.
Myth #5: My patient wasn’t a candidate for transplant, so they aren’t a candidate for CAR T
At least 20-30% of patients treated with commercial therapies for myeloma had never had a prior autologous transplantation, almost 50% are over the age of 65 and 20-25% are older than 70. The physiological stressors posed by CAR T therapy and high-dose melphalan are very different and for that reason, we consider each patient individually. We have a multidisciplinary team that works with each patient, aiming to optimize them for therapy, rather than exclude them on the basis of chronological age or the presence of co-morbidities.
Due to the specialization of our Blood and Marrow Transplant and Cellular Immunotherapy Program (BMT CI), we are able to achieve exceptional outcomes for our patients and also offer transplantation and CAR T services for many patients with potential contraindications.
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