Nutritional and immunologic scoring systems to predict complications and outcomes after anti-B-cell maturation antigen chimeric antigen receptor T-cell therapy in relapsed/refractory multiple myeloma.

BACKGROUND AIMS: Chimeric antigen receptor (CAR) T-cell therapy has significant benefits in the treatment of relapsed/refractory multiple myeloma (R/R MM). Despite the established correlation between nutritional status and the unfavorable prognosis of hematologic malignancies, there remains a paucity of knowledge concerning its predictive value in relation to outcomes and complications arising from CAR T-cell immunotherapy.

METHODS

A retrospective study was conducted based on the LEGEND-2 clinical trial (Xi'an site of phase 1) to evaluate the impact of scores derived from three nutritional and immunologic scoring systems-Controlling Nutritional Status (CONUT), prognostic nutritional index (PNI) and modified Glasgow Prognostic Score (mGPS)-on outcomes and complications after CAR T-cell therapy.

RESULTS

All patients (N = 57) were eligible for the CONUT and PNI, and 24 patients were available for the mGPS. The nutritional status of R/R MM patients who underwent CAR T-cell immunotherapy initially exhibited a decline within the first 2 weeks followed by an improvement 3 weeks after CAR T-cell therapy. We found that an elevated baseline CONUT score (>4) was a risk factor for severe early neutropenia, disseminated intravascular coagulation, prolonged activated partial thromboplastin time and decreased fibrinogen. Low PNI levels (<36.5) were associated with an elevated incidence of hypogammaglobulinemia. Finally, we found an association between baseline mGPS and progression-free survival.

CONCLUSIONS

The CONUT score, PNI and mGPS prior to CAR T-cell immunotherapy offer novel insights into risk stratification in R/R MM patients. Baseline malnutrition might facilitate clinicians in the identification of vulnerable patients to prevent or reduce adverse events and provide individualized management at an early stage.