How would you approach BCMA-directed therapy in a patient with myeloma and renal failure on dialysis?
Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion?
Community PollStarted
How would you dose LD for a patient actually on dialysis receiving BCMA CAR-T?
7 physicians have voted
Join Mednetto vote and see how they answered.
2 Answers
Mednet MemberInvited Expert
Medical Oncology · University of Washington, Fred Hutchinson Cancer Research Center
Answered on
The short answer: Very carefully. Lots of anecdotes and theoretical fears out there, but very little real data to guide us as of July 2023 as I write this. The largest experience with BCMA CAR-T with CKD is this TCT abstract by Sidana and colleagues that I don't think has been published yet:
Join for free or sign in to see the full answer
Mednet Member
Medical Oncology · University of Arkansas for Medical Sciences
Answered on
No right answer.
One approach is lymphodepleting with cyclophosphamide + dose reduced Flu with HD, 12 hours after each dose to limit toxicity. Hunter et al., PMID 35227310
Join for free or sign in to see the full answer