{"entity":{"id":"idea-car-t-replaces-transplant","kind":"idea","name":"One CAR-T infusion instead of autologous transplant","aka":[],"tldr":"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.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT04923893: CARTITUDE-5","url":"https://clinicaltrials.gov/study/NCT04923893"},{"label":"ClinicalTrials.gov NCT04181827: CARTITUDE-4","url":"https://clinicaltrials.gov/study/NCT04181827"}],"tags":[],"related":[],"cancers":["multiple-myeloma"],"sections":[],"technologies":["car-t","autologous-stem-cell-transplant"],"targets":[],"drugs":["ciltacabtagene-autoleucel"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["cartitude-5","cartitude-4"],"people":[],"bottlenecks":[],"keyPapers":["paper-ciltacabtagene-autoleucel-multiple-myeloma-front-immunol-2022","paper-ciltacabtagene-autoleucel-multiple-myeloma-j-clin-oncol-2023","paper-ciltacabtagene-autoleucel-multiple-myeloma-clin-cancer-res-2024"],"journals":[],"dependsOn":[],"notes":[],"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.","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"},"route":"/ideas/idea-car-t-replaces-transplant/","neighbours":{"cancer":[{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"}],"technology":[{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"}],"drug":[{"id":"ciltacabtagene-autoleucel","kind":"drug","name":"Ciltacabtagene autoleucel","route":"/drugs/ciltacabtagene-autoleucel/"}],"trial":[{"id":"cartitude-4","kind":"trial","name":"CARTITUDE-4","route":"/trials/cartitude-4/"},{"id":"cartitude-5","kind":"trial","name":"CARTITUDE-5","route":"/trials/cartitude-5/"}],"paper":[{"id":"paper-ciltacabtagene-autoleucel-multiple-myeloma-front-immunol-2022","kind":"paper","name":"Ciltacabtagene autoleucel: The second anti-BCMA CAR T-cell therapeutic armamentarium of relapsed or refractory multiple myeloma","route":"/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-front-immunol-2022/"},{"id":"paper-ciltacabtagene-autoleucel-multiple-myeloma-clin-cancer-res-2024","kind":"paper","name":"FDA Approval Summary: Ciltacabtagene Autoleucel for Relapsed or Refractory Multiple Myeloma","route":"/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-clin-cancer-res-2024/"},{"id":"paper-ciltacabtagene-autoleucel-multiple-myeloma-j-clin-oncol-2023","kind":"paper","name":"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)","route":"/key-papers/paper-ciltacabtagene-autoleucel-multiple-myeloma-j-clin-oncol-2023/"}]}}