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Gahvari Z, Brunner M, Schmidt T, Callander NS. Update on the current and future use of CAR-T to treat multiple myeloma. Eur J Haematol 2024; 112:493-503. [PMID: 38099401 DOI: 10.1111/ejh.14145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 03/19/2024]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy has become an important intervention in the management of relapsed and relapsed/refractory multiple myeloma (MM). Currently, B-cell maturation antigen (BCMA) is the most targeted surface protein due to its ubiquitous expression on plasma cells, with increasing expression of this essential transmembrane protein on malignant plasma cells as patients develop more advanced disease. This review will explore the earliest CAR-T trials in myeloma, discuss important issues involved in CAR-T manufacturing and processing, as well as review current clinical trials that led to the approval of the two commercially available CAR-T products, Idecabtagene vicleucel and ciltacabtagene autoleucel. The most recent data from trials investigating the use of CAR-T as an earlier line of therapy will be presented. Finally, the problem of relapses after CAR-T will be presented, including several theories as to why CAR-T therapies fail and possible clinical caveats. The next generation of MM-specific CAR-T will likely include new targets such as G-protein-coupled receptor class C, Group 5, member D (GPRC5D) and signaling lymphocyte activation molecular Family 7 (SLAMF7). The role of CAR-T in the treatment of MM will undoubtedly increase exponentially in the next decade.
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Affiliation(s)
- Zhubin Gahvari
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matthew Brunner
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy Schmidt
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Natalie S Callander
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Schmidt T, Gahvari Z, Callander NS. SOHO State of the Art Updates and Next Questions: Diagnosis and Management of Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00115-0. [PMID: 38641486 DOI: 10.1016/j.clml.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024]
Abstract
Monoclonal proteins are common, with a prevalence in the United States around 5% and the incidence increases with age. Although most patients are asymptomatic, the vast majority of cases are caused by a clonal plasma cell disorder. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic precursor conditions with variable risk of progression to multiple myeloma (MM). In recent years, significant progress has been made to better understand the factors that lead to the development of symptoms and progression to myeloma. In this review, we summarize the current diagnosis treatment guidelines for MGUS and SMM and highlight recent advances that underscore a shifting paradigm in the evaluation and management of plasma cell precursor conditions.
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Affiliation(s)
- Timothy Schmidt
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Zhubin Gahvari
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Natalie S Callander
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI.
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Cornell R, Hari P, Tang S, Biran N, Callander N, Chari A, Chhabra S, Fiala MA, Gahvari Z, Gandhi U, Godby K, Gupta R, Jagannath S, Jagosky M, Kang Y, Kansagra A, Kauffman M, Kodali S, Kumar SK, Lakshman A, Liedtke M, Lonial S, Ma X, Malek E, Mansour J, McGehee EF, Neppalli A, Paul B, Richardson P, Scott EC, Shacham S, Shah J, Siegel DS, Umyarova E, Usmani SZ, Varnado W, Vij R, Costa L. Overall survival of patients with triple-class refractory multiple myeloma treated with selinexor plus dexamethasone vs standard of care in MAMMOTH. Am J Hematol 2021; 96:E5-E8. [PMID: 32974944 DOI: 10.1002/ajh.26010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Robert Cornell
- Vanderbilt University Medical Center Nashville, Tennessee
| | | | - Shijie Tang
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Noa Biran
- John Theurer Cancer Center Hackensack University Hackensack, New Jersey
| | | | - Ajai Chari
- Mount Sinai School of Medicine New York, New York
| | | | - Mark A. Fiala
- Washington University School of Medicine St. Louis, Missouri
| | | | | | - Kelly Godby
- University of Alabama at Birmingham Birmingham, Alabama
| | - Ridhi Gupta
- Stanford University School of Medicine Stanford, California
| | | | - Megan Jagosky
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Yubin Kang
- Duke University School of Medicine Durham, North Carolina
| | - Ankit Kansagra
- University of Texas Southwestern Medical Center Dallas, Texas
| | | | - Saranya Kodali
- University of Vermont, College of Medicine Burlington, Vermont
| | | | - Arjun Lakshman
- Department of Internal Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
| | | | | | - Xiwen Ma
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - Ehsan Malek
- Case Western Reserve University Cleveland, Ohio
| | - Joshua Mansour
- City of Hope Comprehensive Center Duarte, California
- Kaiser Permanente Medical Group Los Angeles, California
| | | | | | - Barry Paul
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | - Paul Richardson
- Medical Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston, Massachusetts
| | | | | | - Jatin Shah
- Karyopharm Therapeutics Inc Newton, Massachusetts
| | - David S. Siegel
- John Theurer Cancer Center Hackensack University Medical Center Hackensack, New Jersey
| | - Elvira Umyarova
- University of Vermont, College of Medicine Burlington, Vermont
| | - Saad Z. Usmani
- Levine Cancer Institute/Atrium Health Charlotte, North Carolina
| | | | - Ravi Vij
- Washington University School of Medicine St. Louis, Missouri
| | - Luciano Costa
- University of Alabama at Birmingham Birmingham, Alabama
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Gahvari Z, LoConte NK, Lubner SJ, Mulkerin D, Cho CS, Winslow E, Weber SM, Deming DA. Nab-paclitaxel and gemcitabine for the treatment of pancreatic adenocarcinoma at an academic center. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Zhubin Gahvari
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | | | | | - Emily Winslow
- University of Wisconsin Carbone Cancer Center, Madison, WI
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