Medical Student Scholar Tyra Grischke and Dr. Ben Derman talk about their collaborative study in a Q&A with the IMF
On March 28, Blood Cancer Journal published the study, “Brain-to-vein and vein-to-vein times and outcomes in CAR T-cell therapy in myeloma”—a collaborative research made by Medical Student Scholar Tyra K. Grischke (Indiana University School of Medicine—Indiana, IN) and her mentor, Assistant Professor of Medicine and myeloma expert Dr. Benjamin A. Derman (University of Chicago—Chicago, IL).
Tyra K. Grischke from Indiana University School of Medicine is one of twelve 2024 Medical Student Scholars for Health Equity in Myeloma who were handpicked and paired with myeloma experts to conduct research involving health disparities in myeloma.
Dr. Benjamin A. Derman “specializes in hematology and oncology and is an expert in multiple myeloma and other plasma cell disorders. He also diagnoses and treats cancerous conditions and uses the most innovative techniques, including CAR T-cell therapy and stem cell transplantation to deliver long-term success for his patients,” states his bio in UChicagoMedicine.org. Dr. Derman is actively involved in research work, including minimal residual disease (MRD) testing, new methods and therapies to improve patients’ quality of life and outcomes, as well as “evaluating reasons for racial disparities in multiple myeloma.”
Published in Blood Cancer Journal, the Grischke and Derman study “analyzed brain-to-vein (B2V) and vein-to-vein (V2V) for CAR T-cell therapy in multiple myeloma, exploring their relationship with insurance status, disease characteristics, and patient outcomes” by conducting “a retrospective chart review of 64 consecutive insured patients at the University of Chicago collected for commercial CAR T-cell therapy between April 2021 and June 2024.”
The study investigated on these outcomes of interest: B2V (time from submission of a letter to insurance for approval) and V2V (time from T-cell harvest to infusion), along with incidence/grade of cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), progression-free survival (PFS) and overall survival (OS).
The IMF recently had a Q&A with Tyra and Dr. Derman about their collaborative study.
What are the objectives of the study?
Dr. Derman: When patients proceed with CAR T-cell therapy in myeloma, there are several obstacles that need to be overcome. Sometimes, the biggest hurdle is time itself. I always tell patients considering CAR T-cell therapy that chaos is common, and we specialize in managing the chaos!
[A] patient proceeding to CAR T in the US [will] first need to find a center that offers CAR T. Then, [the patient] needs to get evaluated, obtain insurance approval, and then have their T-cells harvested to enable genetic modification that makes them CAR T-cells. The so-called ‘brain-to-vein’ time is the time it takes just to get to T-cell harvest. Then there is the ‘vein-to-vein’ time which reflects the time it takes to manufacture the CAR T-cells and infuse them back into the patient.
In this study, we sought to understand the interplay between insurance types, the ‘brain-to-vein’ time, and outcomes with CAR T.
What was the ideation process behind the study?
Dr. Derman: When CAR T-cell therapies for myeloma first got approved, we had restricted allotments. We simply couldn’t offer it to all the patients that needed it. Now, we are in a much better state where scarcity is less of an issue. But we still have two issues. The first is that it takes a while for patients to have their cells manufactured. Therefore, patients receiving ‘bridging chemotherapy’ as a means to hold their disease in check while waiting for their cells. Sometimes, this bridging therapy doesn’t work and up to 10% of patients can die waiting for their cells. So, a lot of attention has been paid to ‘vein-to-vein’ time.
We wanted to analyze a very different aspect, the brain-to-vein time. It’s an unseen barrier to care that is often ignored. What I noticed is that patients with Medicare often had no trouble getting CAR T approval – sometimes within 24 hours – but that private insurers often require single case agreements with our institution before they can be approved to proceed. So, we decided to analyze how insurance type may have affected brain-to-vein time and how that may have affected outcomes.
What were the limitations you faced during the course of doing the study?
Dr. Derman: The biggest limitation for us is the small sample size of doing a single institution analysis. There may also be inefficiencies (or efficiencies) about how we go about our insurance approval process that may make our results less generalizable to all US centers.
How does it feel to be published in Blood Cancer Journal? Could you briefly explain the process you went through prior to being published?
Tyra Grischke: Being published in Blood Cancer Journal was an incredibly rewarding experience, especially as a medical student and first-time author. This was the largest project I’ve taken on so far, and it was both exciting and humbling to see it all come together. I’m especially grateful to Dr. Derman, who has been an exceptional mentor throughout the entire process. From the very beginning, he emphasized not just getting results, but learning the skills that would serve me throughout my academic career.
We spent several months meeting regularly to go over the fundamentals of multiple myeloma and CAR T-cell therapy. Dr. Derman shared essential readings that helped me build a strong foundation, and from there we were able to design the study, analyze our dataset, and focus on key findings. I drafted the initial manuscript, and we went through multiple rounds of edits together.
It felt amazing to see our hard work recognized in such a respected journal. I’m incredibly thankful for the time and effort Dr. Derman and his team poured into this project. It’s been a true learning experience that I’ll carry with me moving forward.
Dr. Derman: Anytime I start a project, especially with mentees, I want to make sure we have something to show for our work. Also, I think it’s critical to gain the skills of data acquisition, data analysis, manuscript drafting and editing, and finally submission. These are lifelong skills for those wanting to pursue a career in academia. I’m always grateful when we are able to put all of these aspects together and see that work published.
Tyra and I met several times over a number of months to review the basics of myeloma and CAR T-cell therapy and design this study. I also gave Tyra what I felt were ‘essential reading material’ on the topic, and she clearly demonstrated mastery of this information. From there, we analyzed the dataset that we had and together we narrowed our important findings down to a few key items for the manuscript.
Tyra wrote the first draft and then we went back and forth with edits until we felt it was ready to submit for publication. Following favorable comments from reviewers, we were able to formulate responses and further improve the manuscript before it was finally accepted for publication.
With this important study being published in a major medical journal, what other related research do you think can stem from your initial efforts?
Dr. Derman: I think it would be great to see how our findings stack up with other centers. Are some centers doing a better job at accelerating brain-to-vein time? What lessons can be learned there? I’d also like to see if there are clear interventions that could help speed up the brain-to-vein time (and/or vein-to-vein time) so that patients are not left waiting so long to move forward.
Tyra Grischke: In addition to what Dr. Derman mentioned, I think it would be incredibly valuable to see similar studies conducted in larger and more diverse patient populations. As someone who’s passionate about advocacy and health equity, I’m particularly interested in whether there are disparities in brain-to-vein time based on race or ethnicity in larger populations.
The International Myeloma Foundation (IMF) is truly proud of this remarkable achievement made by one of its own student-mentor pairings for the IMF Medical Student Scholars for Health Equity in Myeloma Mentoring Program. We extend our warmest congratulations to Tyra and Dr. Derman.
To learn more about the Grischke and Derman study, view the full abstract in Blood Cancer Journal.
About the IMF Medical Student Scholars for Health Equity in Myeloma Mentoring Program
Launched on April 20, 2023, the IMF Medical Student Scholars for Health Equity in Myeloma Mentoring Program was created by the IMF, in partnership with the W. Montague Cobb/NMA Health Institute’s Cobb Scholars Program, as a novel mentorship initiative for African American medical students.
The mentoring program is a joint effort by the IMF, the National Medical Association, and the W. Montague Cobb Institute, where medical students of minority backgrounds are paired with myeloma experts to conduct research on health disparities for six months, then are brought together at the National Medical Association Annual Meeting to share their work and form a community of physicians dedicated to health equity in myeloma.