Comparison of Standard-of-Care Idecabtagene Vicleucel and Ciltacabtagene Autoleucel in Relapsed/Refractory Multiple Myeloma
Authors: Hansen Doris K. , Peres Lauren C. , Dima Danai , Richards Alicia , Shune Leyla , Afrough Aimaz , Midha Shonali , Dhakal Binod , Kocoglu Mehmet H. , Atrash Shebli , Ferreri Christopher , Castaneda Omar , Davis James A. , Bhurtel Evguenia , McGuirk Joseph , Wagner Charlotte , Bansal Radhika , Costello Patrick , Smith Kinaya , Lieberman-Cribbin Alex , De Avila Gabriel , Purvey Sneha , Hosoya Hitomi , Mikkilineni Lekha , Oswald Laura B. , Kaur Gurbakhash , Pasvolsky Oren , Gaballa Mahmoud , Herr Megan M. , Forsberg Peter , Janakiram Murali , Htut Myo , Asoori Maringanti Sireesha , Kalariya Nilesh , Hashmi Hamza , Reshef Ran , Sborov Douglas W. , Nadeem Omar , Anwer Faiz , Khouri Jack , Raza Shahzad , Atanackovic Djordje , Alsina Melissa , Freeman Ciara L. , Locke Frederick L. , Voorhees Peter , Anderson Larry D. , Richard Shambavi , Martin Thomas , Lin Yi , Patel Krina K. , Sidana Surbhi ,   on behalf of the US Multiple Myeloma Immunotherapy Consortium
Published: February 2025

PURPOSE
Idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), two B-cell maturation antigen–directed chimeric antigen receptor (CAR) T-cell therapies have demonstrated remarkable efficacy in relapsed/refractory multiple myeloma (RRMM). We compare safety, efficacy, and survival among patients with RRMM treated with standard-of-care (SOC) ide-cel or cilta-cel.

METHODS
Data were from a retrospective chart review of patients with RRMM leukapheresed by December 31, 2022, with the intent to receive SOC ide-cel or cilta-cel at 19 institutions. An inverse probability of treatment weighting (IPTW) approach was used to compare outcomes by therapy type.

RESULTS
A total of 641 patients were leukapheresed by December 31, 2022, with ide-cel (n = 386) and cilta-cel (n = 255). Five hundred eighty-six patients were infused (n = 350 for ide-cel; n = 236 for cilta-cel) with a median follow-up of 12.6 and 13.0 months for ide-cel and cilta-cel, respectively. After IPTW, patient characteristics were well balanced. Cilta-cel was associated with higher likelihood of grade ≥3 cytokine release syndrome (CRS; odds ratio [OR], 6.80 [95% CI, 2.28 to 20.33]), infections (OR, 2.03 [95% CI, 1.41 to 2.92]), second primary malignancies (OR, 1.77 [95% CI, 0.89 to 3.56]), and delayed neurotoxicity (OR, 20.07 [95% CI, 4.46 to 90.20]). Cilta-cel was also associated with better treatment responses (≥complete response: OR, 2.42 [95% CI, 1.63 to 3.60]), longer progression-free survival (hazard ratio [HR], 0.48 [95% CI, 0.36 to 0.63]), and longer overall survival (HR, 0.67 [95% CI, 0.46 to 0.97]). No associations were observed between therapy type and immune effector cell–associated neurotoxicity syndrome, any CRS, severe cytopenia at days 30 and 90, or nonrelapse mortality. We observed consistent findings when repeating the analyses restricting the ide-cel cohort to patients infused during the same time period as Food and Drug Administration approval for cilta-cel (≥March 2022).

CONCLUSION
Cilta-cel demonstrated superior efficacy and survival, with higher incidence of certain toxicities, compared with ide-cel.