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December 8, 2025Blood

Rapid peak CAR-T expansion is associated with delayed neurotoxicity following ciltacabtagene autoleucel in multiple myeloma

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Authors

AVArash VelayatiDDDanai DimaSHSylvester Homsy

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Overview

Analysis shows elevated CAR-T expansion is linked to increased risk of delayed neurotoxicity in multiple myeloma, indicating potential lymphocyte count thresholds for risk stratification.

Key Points

  • Examine the link between peak CAR-T expansion and delayed neurotoxicity in multiple myeloma patients receiving cilta-cel.
  • Included 256 patients with relapsed/refractory multiple myeloma receiving cilta-cel.
  • Measured peak CAR-T expansion using flow cytometry and evaluated absolute lymphocyte count as a surrogate.
  • Identified ALC thresholds to stratify risk of delayed neurotoxicity.
  • 11% of patients experienced delayed neurotoxicity, with cases of cranial nerve palsy and Parkinsonism identified.
  • Peak CAR-T expansion was significantly associated with incidents of delayed neurotoxicity.
  • Optimal ALC thresholds were established for identifying high-risk patients for delayed neurotoxicity.

Cite This Study

Velayati et al. (2025) studied this question.

synapsesocial.com/papers/693624d44fa91c937236cff9https://doi.org/10.1182/blood-2025-96
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Enhancing the safety of ciltacabtagene autoleucel in relapsed multiple myeloma (MM): Identification of potentially modifiable risk-factors associated with delayed neurotoxicity and non-relapse mortality2025 · 7 citations
  2. 2Prognostic impact of CAR-T cell expansion and PD1 expression in patients with DLBCL treated with axicabtagene ciloleucel2025
  3. 3Single-cell transcriptomics reveal mechanisms of efficacy and toxicity in anti-BCMA CAR-T cell therapies for multiple myeloma2025
  4. 4BCMA CAR T-cell expansion dynamics and toxicity after idecabtagene vicleucel and ciltacabtagene autoleucel for multiple myeloma2025
  5. 5Lymphocyte kinetics as a predictor of clinical outcomes following CAR-T therapy for non-Hodgkin lymphoma2025