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"Waitlist mortality" is high for myeloma patients with limited access to BCMA therapy
Nausheen Ahmed1, William Wesson2, Muhammad Umair Mushtaq1
1Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Cancer Center, Westwood, KS, United States.
Background:
The first-in-class approved BCMA CAR-T therapy was idecabtagene vicleucel (ide-cel), approved in March 2021, for RRMM patients who progressed after 4 or more lines of therapy. Despite the promising outcomes, there were limited apheresis/production slots for ide-cel. We report outcomes of patients at our institution who were on the "waitlist" to receive ide-cel in 2021 and who could not secure a slot.
Methods:
We conducted a retrospective review of RRMM patients evaluated at the University of Kansas Cancer Center for ide-cel from 3/2021-7/2021. A retrospective chart review was performed to determine patient and disease characteristics. Descriptive statistics were reported using medians for continuous variables. Survival analysis from initial consult was performed using Kaplan-Meier Survival estimator.
Results:
Forty patients were eligible and were on the "waitlist" for CAR-T. The median follow-up was 14 months (2-25mo). Twenty-four patients (60%) secured a production slot and 16 (40%) did not. The median time from consult to collection was 38 days (8-703). The median time from collection to infusion was 42 days (34-132 days). The median overall survival was higher in the CAR-T group (NR vs 9 mo, p<0.001).
Conclusions:
Many patients who were eligible for ide-cel were not able to secure a timely slot in 2021. Mortality was higher in this group, due to a lack of comparable alternatives. Increasing alternate options as well as improvement in manufacturing and access is an area of high importance to improve RRMM outcomes.
Insights
Patients eligible for idecabtagene vicleucel (ide-cel) CAR-T therapy in 2021 faced significant delays, with those unable to secure a slot experiencing higher mortality. Improving manufacturing and access is crucial for better outcomes in relapsed refractory multiple myeloma (RRMM).
Area of Science:
- Oncology
- Immunotherapy
- Hematology
Background:
- Idecabtagene vicleucel (ide-cel) is the first approved BCMA CAR-T therapy for relapsed refractory multiple myeloma (RRMM) patients post-prior therapy.
- Limited apheresis and production slots for ide-cel led to a patient waitlist in 2021.
- This study evaluates outcomes of RRMM patients on the ide-cel waitlist who could not secure a timely slot.
Purpose of the Study:
- To assess the outcomes of patients with relapsed refractory multiple myeloma (RRMM) who were on a waitlist for idecabtagene vicleucel (ide-cel) CAR-T therapy.
- To compare survival between patients who received ide-cel and those who did not due to slot limitations.
Main Methods:
- Retrospective review of RRMM patients evaluated for ide-cel at the University of Kansas Cancer Center (3/2021-7/2021).
- Chart review for patient and disease characteristics.
- Kaplan-Meier survival analysis from initial consultation.
Main Results:
- Forty patients were waitlisted for ide-cel; 60% secured a slot, 40% did not.
- Median time from consult to collection was 38 days, and collection to infusion was 42 days.
- Median overall survival was significantly higher for patients who received CAR-T (Not Reported vs. 9 months, p<0.001).
Conclusions:
- Many eligible RRMM patients could not access ide-cel in a timely manner in 2021.
- Higher mortality was observed in patients who did not receive CAR-T due to lack of comparable alternatives.
- Enhancing manufacturing capacity and improving access to CAR-T therapies are critical for improving RRMM patient outcomes.
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