AUTHOR=Wang Xue , Qi Yuekun , Li Hujun , Liu Fengan , Cao Jiang , Chen Wei , Wang Ying , Qi Kunming , Yan Zhiling , Zhu Feng , Li Zhenyu , Cheng Hai , Xu Kailin 

TITLE=Impact of glucocorticoids on short-term and long-term outcomes in patients with relapsed/refractory multiple myeloma treated with CAR-T therapy

JOURNAL=Frontiers in Immunology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.943004

DOI=10.3389/fimmu.2022.943004

ISSN=1664-3224

ABSTRACT=Background Glucocorticoids (GCs) are often used  to treat CRS and ICANS. The effect of GCs on the efficacy of CAR-T cell treatment  in RRMM have not been fully established. We evaluated the impact of GCs on clinical outcomes of RRMM patients treated with CAR-T cells.
Methods This study involved RRMM patients treated with CAR-T cells at our center between June 2017 and December 2020 . Patients were stratified into GCs-used group (GC-group) and non-GCs-used group (NGC-group). CRS or ICANS were graded on the basis of the American Society of Transplantation and Cellular Therapy consensus grading system. Response status were evaluated by the IMWG Uniform Response Criteria. The duration of response (DOR), progression-free survival (PFS) and overall survival (OS) were calculated.
Result A total of 71 patients were included in this study. In the NGC-group (40 patients), 34 (85%) had responses to CAR-T cell therapy, including sixteen (40%) stringent complete response(sCR), seven (17.5%)complete response (CR), five (12.5%) very good partial response (VGPR), and six (15%) partial response (PR). The ORR and CRR in the NGC-group were 85% and 57.5%. In the GC-group (31 patients), 29 (93.5%) had responses, including eleven (35.5%) sCR, nine (29%) CR, two (6.4%) VGPR and seven (22.6%) PR. Differences in ORR and CRR between the two groups were insignificant. Dose, duration, and timing of GCs did not affect ORR and CRR. At a median follow-up of 28.2 months, the median PFS was 20.4 months (95% CI, 7.9 to 32.9) while median OS was 36.6 months (95% CI,25.9 to 47.2) for the GC-group. The median PFS and OS for the NGC-group were 13.7months (95% CI, 8.8 to 18.6) and 27.5 months (95% CI, 14.1 to 41.0). There were no significant differences in either PFS or OS between the GC-group and the NGC-group. Earlier, prolonged use and high-dose of GCs were not associated with any effects on  either PFS or OS. Additionally, GCs had no effects on CAR-T cell proliferation.
Conclusion Administration of GCs, dose, timing, and duration doesn’t influence the clinical efficacy of CAR-T cells in RRMM in this study.