Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study

Racial and ethnic minorities have been underrepresented in pivotal trials of idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), limiting the generalizability of findings. This multicenter retrospective study evaluated real-world outcomes in minority patients (MP) versus White patients (WP) treated with cilta-cel or ide-cel across five U.S. centers between May 2022 and April 2024. Among 223 patients, 21% self-identified as racial minorities (39 Black, 2 Asian, 2 Hispanic, 3 other). MPs were younger at infusion (mean age 61.3 vs. 64.8 years; p  = 0.012) and more likely to have impaired renal function (CrCl < 45 mL/min: 22% vs. 8.5%; p  = 0.011). Other baseline disease characteristics were similar between groups. At 6 months, overall response rate (ORR) was 84% in MPs and 71% in WPs. Median progression-free survival was 16.1 months in MPs and 14.1 months in WPs, while median overall survival was 26.4 vs. 27.9 months, respectively; these differences were not statistically significant. Toxicity profiles were comparable overall; however, MPs experienced significantly higher rates of grade 4 neutropenia (41% vs. 21%; p  = 0.01 ). In this real-world cohort, cilta-cel and ide-cel demonstrated similar efficacy and safety in MPs compared to WPs. These results support the use of BCMA-targeted CAR-T therapies across diverse populations and highlight the continued need to improve minority representation in clinical trials to ensure equitable access and outcomes in multiple myeloma care.