Prolonged Cytopenia After Idecabtagene Vicleucel for Multiple Myeloma is Associated with Poor Overall Survival
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Cytopenias are well-recognized toxicities of idecabtagene vicleucel (ide-cel), a chimeric antigen receptor T cell (CAR-T) therapy approved for the treatment of relapsed, refractory multiple myeloma (RRMM). However, little is known of prognostic implications of cytopenias that persist 30 to 100 days after CAR-T infusion. Objective We report the duration, incidence, and impact on outcomes of post-CAR-T cytopenias at Day 30 and Day 100, defined as an absolute neutrophil count of < 500 cells/mm 3 and/or platelet count < 20 × 10 9 cells/L, per the recent definitions of immune effector cell–associated hematotoxicity for neutropenia (N-ICAHT) and thrombocytopenia (T-ICAHT). Study Design Using observational data from the Center for International Blood and Marrow Transplant Research, we identified 821 patients treated during 2021-2023. Results The cumulative incidence of cytopenias at Day 30 was 25% and at Day 100 was 2%. Patients with Day 30 cytopenias had inferior progression-free survival (PFS) (39% vs 45%, P = .01) and overall survival (OS) at 12 months (57% vs 76%, P < .01). While there was no significant difference in PFS in patients who had Day 100 cytopenias (42% vs 53%, P = .12), compared to those who did not, patients with Day 100 cytopenias had significantly inferior OS at 12 months (55% vs 82%, P < .01). High (≥ 2) CAR-HEMATOTOX score was associated with cytopenias at Day 30 (hazard ratio 5.26, P < .001). Conclusion Cytopenias at Day 30 after ide-cel were associated with inferior PFS and OS. In addition, cytopenias at Day 100 after ide-cel are rare and are associated with inferior OS.
Authors: Gurbakhash Kaur, Jennifer Logue, Ruta Brazauskas, Temitope Oloyede, Muhammad Bilal Abid, Sairah Ahmed, Mahmoud Aljurf, Rahul Banerjee, Asad Bashey, Amer M. Beitinjaneh, Natalie S. Callander, Paul Castillo, Bhagirathbhai Dholaria, Scott R. Goldsmith, Shahrukh Hashmi, Mohamed A. Kharfan-Dabaja, Hongtao Liu, Hira Mian, Taiga Nishihori, Kai Rejeski, Ayman Saad, Michael J. Slade, Cameron J. Turtle, Dan T. Vogl, Kirsten M. Williams, Baldeep Wirk, Marcelo C. Pasquini, Amy Moskop, Othman Salim Akhtar, Doris K. Hansen, Murali Janakiram
Institutions: Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Moffitt Cancer Center, Medical College of Wisconsin, Texas Tech University, Texas Tech University Health Sciences Center, The University of Texas MD Anderson Cancer Center, King Faisal Specialist Hospital & Research Centre, University of Washington, Fred Hutch Cancer Center, Northside Hospital, University of Miami Hospital, Sylvester Comprehensive Cancer Center, University of Wisconsin–Madison, University of Wisconsin Carbone Cancer Center, UF Health Shands Hospital, University of Florida Health, Vanderbilt University Medical Center, City Of Hope National Medical Center, City of Hope, Mayo Clinic, Khalifa University of Science and Technology, Sheikh Shakhbout Medical City, Mayo Clinic Comprehensive Cancer Center (Minnesota), Mayo Clinic in Florida, McMaster University, University of South Florida, Memorial Sloan Kettering Cancer Center, Ludwig-Maximilians-Universität München, Washington University in St. Louis, The University of Sydney, Royal North Shore Hospital, Abramson Cancer Center, University of Pennsylvania, Emory University, Children's Healthcare of Atlanta, Virginia Commonwealth University
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
Funders: Gateway for Cancer Research, Amgen, Bristol-Myers Squibb, Pfizer, Astellas Pharma US, AstraZeneca, Sanofi, Gilead Sciences, Alexion Pharmaceuticals, HistoGenetics, Novartis Pharmaceuticals Corporation, CSL Behring, Actinium Pharmaceuticals, Vertex Pharmaceuticals, Jazz Pharmaceuticals, Les Laboratories Pierre Fabre, Mallinckrodt Pharmaceuticals, Atara Biotherapeutics, CareDx, Adaptive Biotechnologies, BeiGene, Incyte, Syndax Pharmaceuticals, Omeros Corporation, Seagen, Kiadis Pharma, Astellas Pharma, Servier, Swedish Orphan Biovitrum, MorphoSys, Medac, National Institutes of Health, Health Resources and Services Administration, Takeda Oncology, Pharmacyclics, Legend Biotech, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases
Awards: G1387388519, G1790975258, G2501228842, G2551907125, G4047589214, G4537600721, G6157636474, G7698102948, G8122297299, G8876996369, Cancer Center Support Grant, A Data Resource for Blood and Marrow Transplants and Adoptive Cellular Therapy Research, Clinical and mechanistic studies defining optimal preparative approaches to infants with IL2RG/JAK3/RAG1/RAG2 SCID: a randomized trial of busulfan dosage, BMT Core - Pediatric Transplantation and Cellular Therapy Consortium (PTCTC): Providing Clinical Trial Access For Children With Life Threatening Diseases
OpenAlex ID: W7164937634