Clinical cancer research : an official journal of the American Association for Cancer Research · 2026
Second Primary Malignancy Risk in Patients with Multiple Myeloma Receiving CAR T-cell Therapy or Other Systemic Anticancer Treatments: A Real-World Comparative Study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Suvannasankha Attaya, Li Mengying, Omofuma Omonefe, Hampp Christian, Phelan Matthew, Breskin Alexander, Shao Ping, Roccia Tito, Mukherjee Nandita, Shrestha Anju, Lee Daniel, Glass Jacob, Kroog Glenn S, Rodriguez Lorenc Karen
Аннотация
PURPOSE: This study aims to compare the risk of second primary malignancy (SPM) between patients with multiple myeloma who received chimeric antigen receptor T-cell (CAR T) therapy versus other systemic anticancer therapies (SACT).
EXPERIMENTAL DESIGN: Adult patients with multiple myeloma who initiated CAR T therapy or other SACT were identified from Komodo Health claims data and weighted to balance baseline characteristics. Cumulative incidence of SPM was estimated over 24 months, and P values were calculated for the difference between 0 and 24 months.
RESULTS: The study included 435 patients who received CAR T therapy and 12,268 patients who received other SACT (median follow-up, 11.8 months). Compared with other SACT, CAR T therapy was associated with similar risks of any SPM (at 24 months, 24.1% vs. 22.3%; P0-24 months = 0.31) and solid SPM (9.1% vs. 11.5%, P0-24 months = 0.32) but significantly higher risk of hematologic SPM (17.9% vs. 13.1%, P0-24 months = 0.04). In a sensitivity analysis requiring ≥ 2 claims to identify an SPM, difference in hematologic SPM risk was attenuated (5.5% vs. 4.9%, P0-24 months = 0.08). Notably, bone marrow examinations were more common after CAR T therapy (e.g., 47% vs. 13% at 0-3 months).
CONCLUSIONS: In this real-world dataset with relatively short follow-up, patients with multiple myeloma seemed to have a higher risk of hematologic SPM after CAR T therapy compared with other SACT. However, misclassification and detection bias cannot be ruled out. The association warrants further evaluation. Physicians should be vigilant for myeloid malignancies after CAR T therapy.
EXPERIMENTAL DESIGN: Adult patients with multiple myeloma who initiated CAR T therapy or other SACT were identified from Komodo Health claims data and weighted to balance baseline characteristics. Cumulative incidence of SPM was estimated over 24 months, and P values were calculated for the difference between 0 and 24 months.
RESULTS: The study included 435 patients who received CAR T therapy and 12,268 patients who received other SACT (median follow-up, 11.8 months). Compared with other SACT, CAR T therapy was associated with similar risks of any SPM (at 24 months, 24.1% vs. 22.3%; P0-24 months = 0.31) and solid SPM (9.1% vs. 11.5%, P0-24 months = 0.32) but significantly higher risk of hematologic SPM (17.9% vs. 13.1%, P0-24 months = 0.04). In a sensitivity analysis requiring ≥ 2 claims to identify an SPM, difference in hematologic SPM risk was attenuated (5.5% vs. 4.9%, P0-24 months = 0.08). Notably, bone marrow examinations were more common after CAR T therapy (e.g., 47% vs. 13% at 0-3 months).
CONCLUSIONS: In this real-world dataset with relatively short follow-up, patients with multiple myeloma seemed to have a higher risk of hematologic SPM after CAR T therapy compared with other SACT. However, misclassification and detection bias cannot be ruled out. The association warrants further evaluation. Physicians should be vigilant for myeloid malignancies after CAR T therapy.