The BOTTOM LINE: CAR T-cell therapy is approved for patients with relapsed/refractory myeloma and who have had four or more prior lines of therapy. CAR T-cell therapy is in limited supply and only available in select specialized centers across the country.
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This week's "Ask Dr. Durie" comes from a patient who has heard about an exciting new therapy called CAR T therapy and wants to know: "Should they be looking into getting CAR T therapy?" Well, this is a very good and important question.
CAR T therapy is a new, very exciting, therapy and very active therapy in which the T cells are harvested from the blood of a patient and then engineered in the lab so that these immune T cells can be given back in the form of a transfusion to fight against the myeloma and achieve what have turned out to be excellent remissions.
And so, there are two commercially available CAR T products available. This means that there is a degree of access right now. But these therapies are available for patients with relapsed/refractory myeloma with active disease. Those are patients who have gone through a lot of prior therapies.
Because of the excitement about the CAR T therapies, the question today comes from a patient who's not in that category. Patients are thinking, "well, maybe this could be a good therapy for me." But it's not currently approved for patients with the earlier disease and certainly not for patients who might already have responded or be in remission.
It's important to be aware that CAR T therapies are approved but in limited supply. There are currently waiting lists for patients to get the CAR T therapy, which is available at, again, a limited number of highly specialized centers across the country.
It's important, also, to be aware that this is certainly not trivial therapy. Most patients will need to have what's called bridging therapy, where the treatment that they're taking is maybe not work too well but they'll need some sort of therapy to keep the myeloma in check until the CAR T cells are manufactured and ready for use in four weeks or so. So, not something that can be done without a lot of preparation and planning.
CAR T-cell therapy is very exciting, very new, and very active. Excellent, deep, responses have occurred, and we're expecting that use of the CAR T therapy in patients with the earlier disease will produce even better lasting remissions, and trials evaluating that are currently in progress.
But for now, the BOTTOM LINE is: If you do have relapsed/refractory myeloma, it could be that you're eligible for CAR T therapy. So, please talk to your doctor about it to see if that is feasible in the area where you live. It may well be that some other kind of therapy maybe is a better option for the time being until CAR T therapy is more broadly accessible.
Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is a co-founder of the IMF.
