ideasIdea
One CAR-T infusion instead of autologous transplant
Replace high-dose melphalan and stem-cell rescue with a single infusion of the patient's engineered T cells after induction.
CARTITUDE-6 (EMagine) randomises Dara-VRd → cilta-cel versus Dara-VRd → transplant; CARTITUDE-5 tests cilta-cel as consolidation where transplant is not planned. CARTITUDE-1 shows a third of late-line patients progression-free at 5 years without maintenance.
Hypothesis
Cilta-cel consolidation after quadruplet induction gives superior sustained MRD negativity and PFS versus transplant, with acceptable neurotoxicity and no second-malignancy excess.
Rationale
Transplant adds PFS but not OS over triplets (DETERMINATION); CAR-T in second line gave OS HR 0.55; earlier use finds fitter T cells and lower tumour burden.
What would test it
CARTITUDE-6 answers this with its primary endpoints (sustained MRD-negative CR, PFS), backed by long-term second-malignancy surveillance.
Maturity
being tested at scale