802MO - Real-world comparison of overall survival between BCMA - bispecific and CAR-T therapies in multiple myeloma

Background

The therapeutic landscape for multiple myeloma (MM) has expanded in the last few decades. For relapsed/refractory MM, teclistamab and two CAR-T therapies, idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), are approved by the FDA after four or more lines of therapy. There is limited data comparing B-cell maturation antigen (BCMA) CAR-T and bispecifics. We report the largest real-world comparison of survival outcomes in patients who received teclistamab versus cilta-cel or ide-cel.

Methods

We used the TriNetX Global Collaborative Network, a de-identified real-world database, to study patients with multiple myeloma who received CAR-T or teclistamab from 2021 to 2023. Cohort 1 received CAR-T without teclistamab, while Cohort 2 received teclistamab without CAR-T. After matching the cohorts, we calculated hazard ratios for 2-year overall survival (OS), CRS, and ICANS and conducted subgroup analyses.

Results

391 CAR-T patients (ide-cel: 277, cilta-cel: 114) and 458 teclistamab patients were included (mean age 66, 54% male). CAR-T showed better OS compared to teclistamab, especially for the cilta-cel group. More CRS was reported with CAR-T, but the incidence of ICANS was similar in both groups. In subgroup analyses, older (age ≥ 70) (OS: HR 0.197, 95% CI: 0.066-0.587; CRS: HR 1.631 95% CI: 1.003-2.651) and those who did not undergo bone marrow transplantation (OS: HR 0.302, 95% CI: 0.163-0.559) especially benefited. Table: 802MO

CRS, cytokine release syndrome; ICANS, immune effector cell-associated neurotoxicity syndrome; HR, hazard ratio; CI, confidence interval

Conclusions

This is the first report comparing survival in a real-world setting between BCMA CAR-Ts and bispecifics. We found that CAR-T improved survival over patients receiving only bispecifics. Older patients and those who did not receive transplants particularly had better OS with CAR-T. Based on our study, we hypothesize that upfront BCMA CAR-T therapy in older transplant-ineligible individuals can improve survival over BCMA bispecifics like teclistamab. Hence, these patients should be especially considered for early BCMA CAR-T.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.