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. 2024 Jun 25;8(12):3246-3253.
doi: 10.1182/bloodadvances.2024012871.

Unscheduled health care interactions in patients with multiple myeloma receiving T-cell redirection therapies

Anna J Howard  1 , Isabel Concepcion  1 , Alice X Wang  1 , Issam S Hamadeh  1 , Malin Hultcrantz  1 , Sham Mailankody  1   2 , Carlyn Tan  1 , Neha Korde  1 , Alexander M Lesokhin  1 , Hani Hassoun  1 , Urvi A Shah  1 , Kylee H Maclachlan  1 , Sridevi Rajeeve  1   2 , Heather J Landau  2   3 , Michael Scordo  2   3 , Gunjan L Shah  2   3 , Oscar B Lahoud  2   3 , David J Chung  2   3 , Sergio Giralt  2   3 , Saad Z Usmani  1   2   3 , Ross S Firestone  1
Affiliations

Unscheduled health care interactions in patients with multiple myeloma receiving T-cell redirection therapies

Anna J Howard et al. Blood Adv. .

Abstract

Outcomes for patients with relapsed/refractory multiple myeloma (R/RMM) have dramatically improved after the development and now growing utilization of B-cell maturation antigen-targeted chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody (BsAb) therapy. However, health care utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled health care interactions (UHIs) among patients with R/RMM responding to B-cell maturation antigen-targeted BsAb and CAR T-cell therapies (N = 46). This included the analysis of remote UHIs including calls to physicians' offices and messages sent through an online patient portal. Our results showed that nearly all patients with R/RMM (89%) receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. Patients with R/RMM responding to BsAbs were significantly more likely to remotely contact their physicians' offices (1.8-fold increase; P = .038) or visit an urgent care center (more than threefold increase; P = .012) than patients with R/RMM responding to CAR T-cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that patients with R/RMM experience while receiving CAR T-cell or BsAb therapies. This preemptive management may significantly reduce unnecessary health care utilization in this vulnerable patient population.

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Conflict of interest statement

Conflict-of-interest disclosure: A.J.H. reports honoraria from Janssen. M.H. reports research funding from Amgen, Daiichi Sankyo, and GlaxoSmithKline, and has received honoraria for consultancy from/participated in advisory boards for Curio Science LLC, Intellisphere LLC, Bristol Myers Squibb (BMS), and GlaxoSmithKline. S.M. received consulting fees from Evicore, Optum, Bio Ascend, Janssen Oncology, BMS, AbbVie, HMP Education, and Legend Biotech, and received honoraria from OncLive, Physician Education Resource, MJH Life Sciences, and Plexus Communications. Memorial Sloan Kettering Cancer Center receives research funding from the NCI, Janssen Oncology, BMS, Allogene Therapeutics, Fate Therapeutics, Caribou Therapeutics, and Takeda Oncology for conducting research. C.T. reports research funding from Janssen and Takeda; personal fees from Physician Educations Resource and MJH Life Sciences; and has participated in advisory boards for Janssen and Sanofi, outside of the submitted work. N.K. reports research funding through Amgen, Janssen, Epizyme, and AbbVie; consults for CCO, OncLive, and Intellisphere Remedy Health; and participated in advisory boards for Janssen and MedImmune. A.M.L. reports grants from Novartis, during the conduct of the study; grants from BMS; personal fees from Trillium Therapeutics; grants, personal fees, and nonfinancial support from Pfizer; grants and personal fees from Janssen, outside the submitted work; and also has a patent US20150037346A1 with royalties paid. H.H. reports grants from Celgene, Takeda, and Janssen, outside the submitted work. U.A.S. reports grants from National Institutes of Health/National Cancer Institute Cancer Center (Support Grant P30 CA008748), MSK Paul Calabresi Career Development Award for Clinical Oncology K12CA184746, Paula and Rodger Riney Foundation, Parker Institute for Cancer Immunotherapy at MSK, HealthTree Foundation, International Myeloma Society, American Society of Hematology, and Allen Foundation Inc, as well as nonfinancial support from American Society of Hematology Clinical Research Training Institute and TREC Training Workshop R25CA203650 (PI: Melinda Irwin); reports other research support from Celgene/BMS and Janssen; and personal fees from ACCC, MashUp MD, Janssen Biotech, Sanofi, BMS, MJH LifeSciences, Intellisphere, Phillips Gilmore Oncology Communications, i3 Health, and RedMedEd. K.H.M. reports grant support from ASH, MMRF, and IMS. H.J.L. has served as a paid consultant for Takeda, Genzyme, Janssen, Karyopharm, Pfizer, Celgene, and Caelum Biosciences, and has received research support from Takeda. M.S. served as a paid consultant for McKinsey & Company, Angiocrine Bioscience, Inc, and Omeros Corporation; received research funding from Angiocrine Bioscience, Inc, Omeros Corporation, and Amgen, Inc; served on ad hoc advisory boards for Kite, a Gilead company; and received honoraria from i3 Health, Medscape, and CancerNetwork for CME-related activity, and IDEOlogy. G.L.S. reports research funding from Janssen, Amgen, BMS, and Beyond Spring, and serves on the data safety monitoring board for ArcellX; research funding to the institution from Janssen, Amgen, BMS, Beyond Spring, and GPCR; and is on the DSMB for ArcellX. O.B.L. reports serving on advisory board for MorphoSys, Kite, Daiichi Sankyo Inc, and Incyte, and has served as a paid consultant for Incyte. D.J.C. receives research funding from Genentech. S.G. reports personal fees and advisory role (scientific advisory board) from Actinium, Celgene, BMS, Sanofi, Amgen, Pfizer, GlaxoSmithKline, Jazz, Janssen, Omeros, Takeda, and Kite, outside the submitted work. S.Z.U. reports grants and personal fees from AbbVie, 404 Amgen, BMS, Celgene, GlaxoSmithKline, Janssen, Merck, MundiPharma, Oncopeptides, 405 Pharmacyclics, Sanofi, Seattle Genetics, SkylineDx, and Takeda. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CONSORT diagram. Recruited patients included patients treated with commercial CAR T-cell and BsAb products, with a response to therapy, who were managed exclusively at our single center, MSKCC.
Figure 2.
Figure 2.
UHIs. Swimmer plot describing patient disposition and the incidence of UHIs among patients included in study cohorts over the 125-day observation period. Symbols indicate UHIs and colors indicate patient disposition for BsAb patients (A) and CAR T patients (B). Tx, treatment.
Figure 3.
Figure 3.
Relative UHI frequency. (A) BsAb patients had more frequent rUHIs during the observation period than CAR T patients. (B) BsAb patients more frequently visited UC center offices during the observation period than CAR T patients. There were no statistically significant differences between the number of ED visits (C) or total inpatient days (D) during the observation period between the 2 cohorts.
Figure 4.
Figure 4.
Accounting for confounders. When stratifying rUHI frequency by top vs bottom age tertiles (A) or prior therapy refractoriness (B), no significant differences in rUHI frequency are observed.
See this image and copyright information in PMC

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