美国 4L+ 复发/难治性多发性骨髓瘤中 CAR-T 细胞治疗与双特异性抗体的治疗排序对长期生存的影响：一项模拟模型

CAR T-cell therapies and bispecific antibodies (BsAb) are increasingly used in 4L+ relapsed/refractory multiple myeloma (RRMM), but long-term data to inform optimal sequencing are limited.

To estimate progression-free survival (PFS), overall survival (OS), and costs associated with CAR T followed by BsAb versus BsAb followed by CAR T in 4L+ RRMM. STUDY DESIGN: A US-based Markov model with time-dependent transitions and a 10-year time horizon compared the two treatment sequences. PFS and OS for starting treatments were sourced from clinical trials; subsequent treatment outcomes were derived from meta-analyses of clinical trials and real-world studies. Probabilistic sensitivity analyses (1,000 simulations) estimated 95% credible ranges. Total costs were calculated using published literature.

CAR T before BsAb resulted in significantly longer survival versus BsAb before CAR T: median PFS 46.4 months (95% CI, 38.3-54.5) vs. 16.8 months (95% CI, 13.2-18.6) (HR 0.36 [95% CI 0.27-0.44]); median OS 61.5 months (95% CI, 53.8-69.9) vs. 32.0 months (95% CI, 13.2-44.5) (HR 0.52 [95% CI 0.26-0.91]). Total 10-year costs were $1,019,513 (95% CI, $934,974-1,105,472) vs. $1,450,958 (95% CI, $1,229,401-1,544,828), yielding cost savings of $431,445 (95% CI, $185,905-556,259).

In this simulation model, using CAR T before BsAb in 4L+ RRMM significantly reduced risk of progression or death by 64%, death by 48%, and lowered overall cost of care versus BsAb before CAR T. These findings support the use of CAR T before BsAb in 4L+ RRMM to improve long-term patient outcomes with substantial cost savings.