CT-511 Clinical Characteristics and Response Outcomes in Older Multiple Myeloma Patients Who Received Idecabtagene Vicleucel: A Single Center Study

Context: Multiple myeloma (MM) is a disease of older adults with a median age of 69y at the time of diagnosis. Older patients remain at higher risk for poor outcomes due to physical and physiological decline with aging. Objectives: To study clinical characteristics and outcomes in older MM patients who received CAR-T therapy. Methods: Charts were reviewed retrospectively for older (≥65y) MM patients who received ide-cel between 8/30/2021-05/31/2022. Descriptive statistics were used to analyze clinical characteristics such as age, polypharmacy, comorbidities, history of fall, peripheral neuropathy (active or history), and organ dysfunction (active or history; cardiac, pulmonary, neuro, and/or renal) at infusion. Response outcomes were evaluated using IMWG criteria with the best overall response rate (ORR) recorded and compared to KarMMa study results for older patients (≥65y, n=45) (Munshi et al., NEJM 2021; 384:705-716). Results: In 16 patients (median: 70y, range: 65-83y) (75% ineligible for KarMMa trial), the prevalence of polypharmacy (5+ drugs), excessive polypharmacy (10+ drugs), 4+ comorbidities, history of falls, neuropathy, and organ dysfunction was 94%, 56%, 81%, 37%, 62%, and 50% respectively. Ten patients with ≥30 days of follow up were analyzed for response outcomes. With a median follow up duration of 3.2 months, best ORR was 70% (3 sCR, 1 CR, 2 VGPR, 1 PR, 3 SD/MR), which was comparable to KarMMa study results (ORR > 50%, 95% CI). CRS was grade 1-2 and no major adverse events observed. In a subgroup analysis of eight patients (>70y old), the prevalence of the above characteristics was 100%, 87%, 87%, 37%, 62%, and 62% respectively. For six patients with a median follow up of 4.2 months, best ORR was 100% (2 sCR, 1 CR, 2 VGPR, 1 PR), which was better than KarMMa study results (ORR > 50%, 95% CI). Conclusions: In this small group of older patients, the prevalence of polypharmacy, comorbidities, history of falls, and peripheral neuropathy were higher compared to published reports for general and/or oncology older population. Robust responses and no major toxicities were observed in all patients, especially septua & octogenarians, despite their physical and physiological limitations.