Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia
BackgroundRegulatory bodies have recently approved chimeric antigen receptor (CAR)-T cell therapies for patients with multiple myeloma (MM), but the treatment process involves complex decision making. To support the introduction of these therapies, we aimed to establish consensus expert opinion on b...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1535869/full |
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| author | P. Joy Ho Hang Quach M. Hasib Sidiqi M. Hasib Sidiqi Cindy H. Lee Jason Butler Andrew Spencer Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Jingya Li Elissa Cusson Robert Bagnall Simon J. Harrison |
| author_facet | P. Joy Ho Hang Quach M. Hasib Sidiqi M. Hasib Sidiqi Cindy H. Lee Jason Butler Andrew Spencer Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Jingya Li Elissa Cusson Robert Bagnall Simon J. Harrison |
| author_sort | P. Joy Ho |
| collection | DOAJ |
| description | BackgroundRegulatory bodies have recently approved chimeric antigen receptor (CAR)-T cell therapies for patients with multiple myeloma (MM), but the treatment process involves complex decision making. To support the introduction of these therapies, we aimed to establish consensus expert opinion on best practices of all aspects of the management of patients with MM undergoing CAR-T cell therapy in Australia.MethodsWe conducted a modified RAND/UCLA two-round Delphi panel informed by a systematic literature review (SLR). The SLR included evidence from clinical practice guidelines, interventional trials, and observational studies for CAR-T cell therapy for patients with MM, to synthesize methodological aspects of CAR-T cell therapy related to patient management. The Delphi panel comprised eight hematologists from across Australia, each with significant experience directly treating patients using CAR-T therapy or referring patients for CAR-T cell therapy. Panelists completed the surveys electronically, and attended a virtual meeting held before the second-round questionnaire to discuss the first-round questionnaire responses. Consensus was defined a priori as at least 70% agreement on survey questions.ResultsThe SLR identified 22 interventional or observational studies and 5 clinical practice guidelines reporting on selection and management of patients with MM treated with CAR-T cell therapy from various global regions. The Delphi panel reached consensus on practices related to patient referral, screening, selection, prioritization, treatments requiring wash-out, bridging therapy, lymphodepletion, infusion, and post-infusion monitoring and management. Most consensus results aligned with consistently recommended practices within guidelines included in the SLR. Consensus was not reached for statements related to specific screening practices and post-treatment monitoring, suggesting differing opinions on the specific best practices to implement.ConclusionOur Delphi panel established expert consensus on key considerations for patient selection, administrative processes, and aftercare for patients with MM in Australia undergoing CAR-T therapy. This will guide the development of clinical practice guidelines which are relevant and feasible to Australian health systems. |
| format | Article |
| id | doaj-art-ebd17a607c18497fa0f152230c94747b |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-ebd17a607c18497fa0f152230c94747b2025-01-21T08:36:56ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011410.3389/fonc.2024.15358691535869Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in AustraliaP. Joy Ho0Hang Quach1M. Hasib Sidiqi2M. Hasib Sidiqi3Cindy H. Lee4Jason Butler5Andrew Spencer6Kenneth Micklethwaite7Kenneth Micklethwaite8Kenneth Micklethwaite9Kenneth Micklethwaite10Jingya Li11Elissa Cusson12Robert Bagnall13Simon J. Harrison14Institute of Haematology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, AustraliaDepartment of Hematology, St. Vincent’s Hospital Melbourne and University of Melbourne, Melbourne, VIC, AustraliaCurtin Medical School, Curtin University, Perth, WA, AustraliaHaematology Department, Fiona Stanley Hospital, Murdoch, WA, AustraliaDepartment of Clinical Haematology, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, AustraliaDepartment of Haematology and Bone Marrow Transplant, Royal Brisbane and Women’s Hospital, Herston, QLD, AustraliaDepartment of Clinical Haematology, Alfred Hospital, Melbourne, VIC, AustraliaBlood Transplant and Cell Therapies Program, Department of Haematology, Westmead, NSW, AustraliaNSW Health Pathology Blood Transplant and Cell Therapies Laboratory – Institute Of Clinical Pathology And Medical Research (ICPMR) Westmead, Sydney, NSW, Australia Hospital, Sydney, NSW, Australia0Westmead Institute for Medical Research, Sydney, NSW, Australia1Sydney Medical School, The University of Sydney, Sydney, NSW, Australia2Health Economics and Market Access, Amaris Consulting, Shanghai, China3Health Economics and Market Access, Amaris Consulting, Barcelona, Spain3Health Economics and Market Access, Amaris Consulting, Barcelona, Spain4Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, AustraliaBackgroundRegulatory bodies have recently approved chimeric antigen receptor (CAR)-T cell therapies for patients with multiple myeloma (MM), but the treatment process involves complex decision making. To support the introduction of these therapies, we aimed to establish consensus expert opinion on best practices of all aspects of the management of patients with MM undergoing CAR-T cell therapy in Australia.MethodsWe conducted a modified RAND/UCLA two-round Delphi panel informed by a systematic literature review (SLR). The SLR included evidence from clinical practice guidelines, interventional trials, and observational studies for CAR-T cell therapy for patients with MM, to synthesize methodological aspects of CAR-T cell therapy related to patient management. The Delphi panel comprised eight hematologists from across Australia, each with significant experience directly treating patients using CAR-T therapy or referring patients for CAR-T cell therapy. Panelists completed the surveys electronically, and attended a virtual meeting held before the second-round questionnaire to discuss the first-round questionnaire responses. Consensus was defined a priori as at least 70% agreement on survey questions.ResultsThe SLR identified 22 interventional or observational studies and 5 clinical practice guidelines reporting on selection and management of patients with MM treated with CAR-T cell therapy from various global regions. The Delphi panel reached consensus on practices related to patient referral, screening, selection, prioritization, treatments requiring wash-out, bridging therapy, lymphodepletion, infusion, and post-infusion monitoring and management. Most consensus results aligned with consistently recommended practices within guidelines included in the SLR. Consensus was not reached for statements related to specific screening practices and post-treatment monitoring, suggesting differing opinions on the specific best practices to implement.ConclusionOur Delphi panel established expert consensus on key considerations for patient selection, administrative processes, and aftercare for patients with MM in Australia undergoing CAR-T therapy. This will guide the development of clinical practice guidelines which are relevant and feasible to Australian health systems.https://www.frontiersin.org/articles/10.3389/fonc.2024.1535869/fullchimeric antigen receptor immunotherapyCAR-T cell therapysystematic reviewDelphi studymultiple myelomaconsensus development |
| spellingShingle | P. Joy Ho Hang Quach M. Hasib Sidiqi M. Hasib Sidiqi Cindy H. Lee Jason Butler Andrew Spencer Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Kenneth Micklethwaite Jingya Li Elissa Cusson Robert Bagnall Simon J. Harrison Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia Frontiers in Oncology chimeric antigen receptor immunotherapy CAR-T cell therapy systematic review Delphi study multiple myeloma consensus development |
| title | Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia |
| title_full | Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia |
| title_fullStr | Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia |
| title_full_unstemmed | Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia |
| title_short | Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia |
| title_sort | management of car t cell therapy in patients with multiple myeloma a systematic review and expert consensus in australia |
| topic | chimeric antigen receptor immunotherapy CAR-T cell therapy systematic review Delphi study multiple myeloma consensus development |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1535869/full |
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