Survivorship in Patients with Multiple Myeloma Treated with Chimeric Antigen Receptor T-cell Therapy - PROJECT SUMMARY/ABSTRACT
Multiple myeloma is the second most common hematologic cancer in the US and remains incurable, with virtually
all patients developing relapsed or refractory disease after initial therapy. Chimeric antigen receptor T-cell
therapy (CAR T) is a revolutionary new treatment for patients with relapsed/refractory multiple myeloma (RRMM)
who have progressed on several prior treatments and have limited treatment options remaining. In clinical trials,
RRMM patients treated with CAR T showed unprecedented treatment response rates and improved patient-
reported outcomes (PROs), such as health-related quality of life (HRQOL) and symptom burden. CAR T is now
available to RRMM patients as standard of care, offering patients new hope for durable remission and better
HRQOL. However, clinical trials had stringent eligibility criteria and lacked racial and ethnic diversity, which limits
the generalizability of findings to RRMM patients treated in standard of care. To address this limitation, we will
establish a first-in-kind prospective cohort of real-world RRMM CAR T recipients at Moffitt Cancer Center, one
of the leading high-volume US institutions offering standard of care CAR T for diverse RRMM patients. Within
an evidence-based psychoneuroimmunology framework, we will evaluate psychosocial factors (i.e., depression,
anxiety, social support) and immune-related factors (i.e., systemic inflammation, bone marrow immune
microenvironment) as they relate to key clinical and patient-reported survivorship outcomes (i.e., incidence and
severity of CAR T toxicities, treatment response, progression-free survival, HRQOL, and symptom burden).
Immune-related factors may be especially relevant to this population’s survivorship, as CAR T harnesses a
patient’s own immune system to kill cancer cells, and recipients can experience potentially life-threatening
immune-mediated toxicities. Participants will complete PRO assessments and provide blood specimen samples
for quantification of immune biomarkers at clinically defined timepoints, from pre-CAR T infusion (i.e., baseline)
through one year. We will also use multiplex immunofluorescence staining and novel statistical methods
developed by our team to characterize the abundance and spatial relationships of immune cells in the bone
marrow microenvironment. This resource of highly phenotyped RRMM patients with systematically collected
PRO data and biospecimens will allow us to identify psychosocial factors (Aim 1) and immune-related factors
(Aim 2) associated with key clinical and patient-reported survivorship outcomes among real-world patients
treated with CAR T as part of standard of care. Study findings will have direct clinical implications. Identifying
psychosocial and immune-related factors associated with CAR T survivorship outcomes will inform the
development of patient education and clinical decision-making tools. Findings will also elucidate modifiable
targets for developing and implementing supportive care interventions and use of inflammation-reducing
medications. Long-term, this research will improve survivorship for RRMM patients treated with CAR T, a growing
yet understudied population living with incurable cancer.
