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Anti B-cell maturation antigen CAR T-cell and antibody drug conjugate therapy for heavily pre-treated relapsed and refractory multiple myeloma: final report
Anti B-cell maturation antigen CAR T-cell and antibody drug conjugate therapy for heavily pre-treated relapsed and refractory multiple myeloma: final report
Our systematic review of the evidence suggests that CAR T-cell therapies for patients with triple-or quad- refractory multiple myeloma likely provides small to substantial net health benefits over current usual care. Benefits included longer survival as well as improved quality of life. Counterbalancing these benefits were the harms, including cytokine release syndrome, which is temporary but often requires hospitalization and intensive care unit level care. Our systematic review of cilta-cel and ide-cel suggests that the evidence is insufficient to determine whether one agent is superior to the other. There are no studies comparing these agents directly, nor sufficient data to perform quantitative indirect comparisons. We conclude that belantamab is promising but inconclusive compared to usual care for patients with triple-, quad- and penta- refractory multiple myeloma exposed to 4+ prior lines of treatment. The overall response ratio and overall survival suggests a possible small net benefit. However, the frequency and severity of visual impairment and lack of demonstrated improvement in health-related quality of life suggests that any net benefits are likely to be modest. The current evidence precludes a substantial benefit; additional data is required to preclude small overall net harm.
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