Managing Cranial Nerve Impairment in Multiple Myeloma Following Cilta-cel

It is critical to quickly conduct neurological workups to verify cases of cranial nerve palsy (CNP) in patients with multiple myeloma who receive treatment with ciltacabtagene autoleucel (cilta-cel; Carvykti), according to Leslie Bennett, MSN, RN.

Bennett, a nurse coordinator at Stanford Healthcare, spoke with CancerNetwork^® during the 2024 Oncology Nursing Society Conference about the importance of clinicians and nurse providers preparing for CNP in patients who undergo treatment with cilta-cel for multiple myeloma. She stated that nurses, in particular, should be educated on this toxicity so that they can identify and subsequently mitigate symptoms in patients who may experience CNP before, during, or after CAR T-cell infusion.

In a poster presentation given at the conference, Bennett highlighted findings on CNP outcomes from the phase 1/2 CARTITUDE-1 trial (NCT03548207), phase 2 CARTITUDE-2 trial (NCT04133636), and phase 3 CARTITUDE-4 trial (NCT04181827), which assessed the use of cilta-cel in various populations with multiple myeloma. Across these trials, patients had CNP onset at a median of approximately 3 weeks following treatment with cilta-cel. Additionally, most cases of CNP affected male patients and were typically low-grade.

Transcript:

[Cranial nerve impairments are] something that we do discuss in the new patient visit, when the patients are being consented, and when we’re talking about all the neurological toxicities, including the fact that they could have the cranial nerve VII impairment causing the palsy typically during delayed onset.

It’s good for nurses, specifically, to be educated on this so that they can prepare their patients and the caregivers before, during, and after their CAR T infusions so that they can find the signs and symptoms and adequately get them addressed. It’s important to have a rapid neurological workup to ensure that what indeed is happening is a nerve palsy and not another neurological [adverse] effect from the CAR T therapy.

Reference

Bennett L, Kruyswijk S, Sidana S, et al. Incidence and management of cranial nerve impairments in patients with multiple myeloma treated with ciltacabtagene autoleucel in CARTITUDE studies. Presented at the 49th Annual Oncology Nursing Society Conference; April 24-28, 2024; Washington, DC.