Abstract
Abstract
Background
Ciltacabtagene autoleucel (cilta‐cel), an anti–B‐cell maturation antigen (BCMA) chimeric antigen receptor T‐cell (CAR‐T) therapy, is approved for relapsed/refractory multiple myeloma (RRMM).
Methods
Using the Center for International Blood and Marrow Transplant Research registry, this study evaluated outcomes of frail patients receiving commercial cilta‐cel from March 2022 to December 2023. Frailty was defined by an adapted simplified score incorporating age, performance status, and comorbidities.
Results
Among 541 patients with available frailty status, 183 (33.8%) were frail and 358 (66.2%) were nonfrail. Overall response rates were comparable (frail 82.8% vs. nonfrail 88.5%). However, frail patients had inferior progression‐free survival (PFS) (12‐month PFS, 62.7% [95% confidence interval (CI), 53.6%–71.3%] vs. 75.9% [95% CI, 70.4%–81.1%];
p
p
p
= .12. Cytokine release syndrome (grade ≥2) occurred in 22.4% of frail versus 17.9% of nonfrail patients (
p
= .05), and immune effector cell–associated neurotoxicity (ICANS) of any grade was reported in 32.2% versus 17.6% (
p
day 30) was more common in frail patients (30.6% vs. 21.2%;
p
p
Conclusions
Cilta‐cel remains effective in frail RRMM, but frailty is associated with reduced survival and increased toxicity, supporting tailored CAR‐T strategies.