This real-world retrospective study evaluated immunological predictors of response and progression-free survival (PFS) in 90 consecutive RRMM patients treated with commercial ide-cel at a single French center between October 2021 and December 2024, with a median follow-up of 12 months.
Peak CAR T-cell expansion (Cmax) ≥100 cells/μL was the strongest independent predictor of PFS (adjusted HR 0.18; 95% CI 0.08–0.38; P<0.001); responders had a median Cmax of 398 vs. 46 CAR T/μL in failures, and a median PFS of 18.9 vs. 3.3 months. High Cmax also appeared to neutralize the adverse effect of intermediate/high MyCARe risk.
Single-center retrospective design limits generalizability; relatively small cohort (n=90) may reduce statistical power for subgroup analyses; median follow-up of only 12 months may not capture late relapses.
Monitor CAR T-cell expansion closely after ide-cel infusion — a peak count ≥100 cells/μL by Day 28 identifies patients likely to achieve durable responses, while those below this threshold warrant early consideration of adjunctive strategies (e.g., immunomodulatory agents, checkpoint inhibitors) to rescue suboptimal expansion.
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