Absolute Lymphocyte Count and Outcomes of Multiple Myeloma Patients Treated with Idecabtagene Vicleucel: The US Myeloma Immunotherapy Consortium Real- World Experience

Jack Khouri, Danai Dima, Hong Li, Doris Hansen, Surbhi Sidana, Leyla Shune, Faiz Anwer, Douglas Sborov, Charlotte Wagner, Mehmet H. Kocoglu, Shebli Atrash, Peter Voorhees, Lauren Peres, Vanna Hovanky, Gary Simmons, Louis Williams, Shahzad Raza, Aimaz Afrough, Larry D. Anderson, Christopher FerreriHamza Hashmi, James Davis, Joseph McGuirk, Scott Goldsmith, Azra Borogovac, Yi Lin, Shonali Midha, Omar Nadeem, Frederick L. Locke, Rachid Baz, Betty Hamilton, Melissa Alsina, Craig Sauter, Krina Patel, Gurbakhash Kaur

Research output: Contribution to journalArticlepeer-review

Abstract

Idecabtagene vicleucel (ide-cel) has shown impressive efficacy in relapsed/refractory multiple myeloma (RRMM). This study aimed to investigate the impact of absolute lymphocyte count (ALC) on the survival outcomes of RRMM patients treated with standard of care (SOC) ide-cel. Data were collected retrospectively from 11 institutions in the U.S. Impact of ALC parameters including pre-apheresis (pre-A), pre-lymphodepletion (pre-LD), absolute and percent difference from pre-A to pre-LD on clinical outcomes after ide-cel were examined using survival analysis. A new ALC profile was created based on univariate analysis that comprises 3 groups: normal (≥1 × 109/L) pre-LD ALC (LDN), low (<1 × 109/L) pre-LD ALC (LDL) + percent reduction <37.5 (%RL), and LDL ALC + percent reduction ≥37.5 (%RH). A total of 214 SOC ide-cel recipients were included in this analysis. The median patient age was 64 years (interquartile range [IQR], 57 to 69 years), median number of prior therapies was 6 (IQR, 5 to 9), and median duration of follow-up was 5.4 months (IQR, 2.1 to 8.3 months). Most patients had both low pre-A ALC (75.3%) and pre-LD ALC (77.2%), and the reduction from pre-A to pre-LD (median, .65 to .55 × 109/L) was statistically significant. Univariate analysis showed that the LDL + %RH group had significantly worse progression-free survival (PFS) and overall survival (OS) compared to the LDL + %RL and LDN ALC groups (6-month PFS: 40% versus 67.6% and 60.9%; 6-month OS: 69.5% versus 87% and 94.3%). In multivariable analysis, after adjusting for age, performance status, cytogenetic risk, use of bridging therapy, and extramedullary disease, PFS did not maintain its statistical significance; however, OS remained significantly worse for LDL + %RH group compared to the LDN ALC group (hazard ratio [HR], 4.3; 95% confidence interval [CI], 1.1 to 17), but the difference between the LDL + %RH versus %RL groups was not statistically significant (HR, 1.7; 95% CI, .8 to 4.0). Our findings indicate that low pre-LD ALC with high %R from pre-A to pre-LD was associated with inferior survival outcomes, particularly OS, in patients who received SOC ide-cel.

Original languageEnglish (US)
Pages (from-to)790.e1-790.e16
JournalTransplantation and Cellular Therapy
Volume30
Issue number8
DOIs
StatePublished - Aug 2024

Keywords

  • Absolute lymphocyte count
  • Idecabtagene vicleucel
  • Multiple myeloma
  • Relapsed-refractory

ASJC Scopus subject areas

  • Immunology and Allergy
  • Molecular Medicine
  • Hematology
  • Cell Biology
  • Transplantation

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