Chimeric Antigen Receptor T-Cell Therapy in Dialysis-Dependent Patients With Multiple Myeloma: Insights From a 5-Case...

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative treatment for multiple hematologic malignancies, including multiple myeloma. However, patients with advanced chronic kidney disease, particularly those who are dialysis-dependent, have generally been excluded from clinical trials, leaving a significant gap in evidence regarding the safety and feasibility of CAR T-cell therapy in these patients. Concerns in this patient population include potential toxicity from lymphodepleting chemotherapy regimens and increased susceptibility to immune-related adverse events such as cytokine release syndrome and neurotoxicity. While limited case reports suggest feasibility in patients with lymphoma and kidney impairment, data on CAR T-cell use in dialysis-dependent patients with multiple myeloma remain scarce. We present a case series of 5 dialysis-dependent patients with relapsed/refractory multiple myeloma who were successfully treated with ciltacabtagene autoleucel. This series highlights the potential for safe and effective administration of CAR T-cell therapy in dialysis-dependent patients, supporting the need for broader inclusion of this population in future studies.