# One CAR-T infusion instead of autologous transplant

Source: https://onco.cc/ideas/idea-car-t-replaces-transplant/  
OnCo record `idea-car-t-replaces-transplant` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Replace high-dose melphalan and stem-cell rescue with a single infusion of the patient's engineered T cells after induction.

## Summary

Instead of high-dose melphalan and stem cell rescue, this idea would consolidate newly diagnosed multiple myeloma with a single infusion of ciltacabtagene autoleucel after quadruplet induction. The rationale is that transplant adds progression-free but not overall survival over triplets in DETERMINATION, that cilta-cel improved survival in the second line in CARTITUDE-4, and that earlier use finds fitter T cells and lower tumour burden. The hypothesis is that cilta-cel consolidation gives superior sustained MRD negativity and progression-free survival versus transplant without excess second cancers. CARTITUDE-6 (EMagine) randomises Dara-VRd then cilta-cel against Dara-VRd then transplant, and CARTITUDE-5 tests cilta-cel where transplant is not planned; it is being tested at scale.

## Fields

- Kind: Idea
- Last checked: 2026-09-07
- 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.
- Proposed test: 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

## Sources

- ClinicalTrials.gov NCT04923893: CARTITUDE-5: https://clinicaltrials.gov/study/NCT04923893
- ClinicalTrials.gov NCT04181827: CARTITUDE-4: https://clinicaltrials.gov/study/NCT04181827

## Connected records

- cancers: [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- drugs: [Ciltacabtagene autoleucel](https://onco.cc/drugs/ciltacabtagene-autoleucel/)
- trials: [CARTITUDE-4](https://onco.cc/trials/cartitude-4/), [CARTITUDE-5](https://onco.cc/trials/cartitude-5/)
- key papers: [Ciltacabtagene autoleucel: The second anti-BCMA CAR T-cell therapeutic armamentarium of relapsed or refractory multiple myeloma](https://onco.cc/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-front-immunol-2022/), [FDA Approval Summary: Ciltacabtagene Autoleucel for Relapsed or Refractory Multiple Myeloma](https://onco.cc/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-clin-cancer-res-2024/), [Phase II, Open-Label Study of Ciltacabtagene Autoleucel, an Anti-B-Cell Maturation Antigen Chimeric Antigen Receptor-T-Cell Therapy, in Chinese Patients With Relapsed/Refractory Multiple Myeloma (CARTIFAN-1)](https://onco.cc/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-j-clin-oncol-2023/)

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