Oncology News Central (ONC)Deaths Among Cancer Patients on CAR-T Therapies: New Study Probes Nonrelapse Causes

Infections Emerge as Leading Cause of Nonrelapse Mortality in CAR T-Cell Therapy

A recent study has shed light on the causes of nonrelapse mortality (NRM) in patients undergoing CAR T-cell therapy for lymphoma and multiple myeloma. The research, conducted by Dr. Kai Rejeski and colleagues at Memorial Sloan Kettering Cancer Center, analyzed data from 7,604 patients across 46 studies. The findings reveal that infections account for more than half of nonrelapse deaths, highlighting a critical area for improvement in patient care and outcomes.

Key Points:

• The study examined nonrelapse mortality (NRM) in CAR T-cell therapy patients with lymphoma and multiple myeloma up to March 2024.
• Data from 7,604 patients across 18 clinical trials and 28 real-world studies were analyzed.
• The overall NRM point estimate was 6.8%, indicating about 1 in 15 patients died from a nonrelapse-related cause.
• NRM estimates varied by disease type:
  • Mantle cell lymphoma: 10.6%
  • Multiple myeloma: 8.0%
  • Large B-cell lymphoma: 6.1%
  • Indolent lymphoma: 5.7%
• Of the 574 nonrelapse deaths reported:
  • 50.9% were attributed to infections
  • 7.8% were due to other malignancies
  • 7.3% resulted from cardiovascular or respiratory events
  • 11.5% were caused by CAR-T therapy-specific toxicities (ICANS, CRS, HLA)
• Axicabtagene ciloleucel for large B-cell lymphoma and ciltacabtagene autoleucel for multiple myeloma were independently associated with increased NRM point estimates.
• The study suggests a need for better characterization of infectious complications associated with CAR T-cell therapy.
• Successful management of CRS and ICANS has decreased their impact on NRM.
• The majority of deaths after CAR T-cell therapy are still due to cancer relapse, not NRM.
• Experts suggest developing strategies to improve patients’ immune reconstitution after CAR T-cell therapy.
• Possible interventions to prevent infections include prophylactic antibiotics and increased use of IVIG.
• NRM is one of many factors to consider when choosing between CAR T-cell products, along with efficacy, logistics, and cost.

The global CAR T-cell therapy market size was valued at USD 2.75 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 23.32% from 2023 to 2030. (Grand View Research)

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