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Pathogenesis and Treatment Strategies in Multiple Myeloma: From Basic Research to Real Life: 2nd Edition

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Dr. Shingen Nakamura

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Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8503, Japan
Interests: myeloma bone disease; infectious disease in myeloma; proteasome inhibitor; IMiDs; anti-CD38 antibody; venetoclax; immunotherapy
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Dear Colleagues,

This Special Issue is the second edition of a previous Special Issue entitled “Pathogenesis and Treatment Strategies in Multiple Myeloma: From Basic Research to Real Life” (https://www.mdpi.com/journal/cancers/special_issues/PD380C657X).

This Special Issue aims to bridge the gap between basic research and clinical practice by providing insights into the underlying mechanisms of multiple myeloma and exploring novel therapeutic approaches. We welcome original articles and comprehensive reviews that dig into various aspects of multiple myeloma, including its molecular pathogenesis, genetic abnormalities, and immune dysregulation with related infectious complications. We also highlight the advancements in diagnostic techniques, prognostic markers, and risk stratification, which play a crucial role in tailoring patients’ personalized treatment plans. Additionally, we discuss the latest developments in targeted therapies, immunotherapies, and combination treatment regimens, shedding light on their efficacy and potential side effects. Furthermore, this Special Issue emphasizes the importance of translational research and the integration of basic science with clinical practice.

Dr. Shingen Nakamura
Guest Editor

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14 pages, 4283 KB

Open AccessArticle

Investigating CAR-T Treatment Access for Multiple Myeloma Patients Using Real-World Evidence

by Jaysón Davidson, Anupama Kumar, Ayan Patel, Irene Y. Chen, Atul J. Butte and Travis Zack

Cancers 2026, 18(4), 669; https://doi.org/10.3390/cancers18040669 - 18 Feb 2026

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Abstract

Importance: Multiple myeloma (MM) is the second most common hematologic malignancy in the U.S., with a higher incidence among Black patients than White patients. Chimeric antigen receptor T-cell (CAR-T) therapies show clinical promise, but their limited availability raises concerns about access. Objective: To examine associations between disease characteristics, treatment location, and patient demographics with receipt of CAR-T therapy among patients with MM. Design: Retrospective cohort study using electronic health record data from the University of California Health Data Warehouse (UCHDW) between January 2021 and January 2025. Setting: Six academic health centers and twelve affiliated hospitals within the UCHDW. Participants: A population-based cohort of 12,360 adult patients diagnosed with MM and treated at a University of California facility offering CAR-T administration. Analyses were conducted from February 2025 to March 2025. Exposures: Receipt of multiple cancer therapies following MM diagnosis. Main Outcomes and Measures: Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between disease characteristics, treatment locations, and patient demographics with receipt of CAR-T therapy. A zero-shot GPT-4 inference model was applied to UCSF clinical notes to assess whether CAR-T therapy was discussed, determine documented eligibility, and classify rationale for eligibility determinations. Results: Among 12,360 patients with MM (mean age, 68.5 years; 51.6% male), 320 (2.6%) received CAR-T therapy. Disease characteristics at diagnosis, measured by the International Staging System (ISS), was distributed as follows: Stage I (65.3%), Stage II (24.4%), Stage III (2.8%), and Unknown (7.5%). Patients treated at UC-1 (49.3%), and UC-2 (50.0%) were more frequently diagnosed with ISS Stage II, whereas patients treated at UC-3 (55.5%) were more frequently diagnosed with ISS Stage I. Our model showed that patients identifying as Black or African American had lower odds of receiving CAR-T therapy compared with White patients (OR, 0.33; [95% CI, 0.17–0.62]). Patients treated at UC-3 also had lower odds of receiving CAR-T therapy compared with UC-1 (OR, 0.42; [95% CI, 0.30–0.59]). Among 270 UCSF patients assessed for CAR-T eligibility using clinical notes, the proportion of patients deemed eligible without documented CAR-T discussions was highest among those identifying as Other Pacific Islander (50%), followed by Black or African American (4.2%), Asian (3.2%), and White patients (0.6%). Conclusions and Relevance: Within a large academic health system, receipt of CAR-T therapy varied by treatment location and patient-reported race. A subset of patients with documented eligibility lacked recorded discussions of CAR-T therapy, suggesting potential differences in referral, documentation, or care pathways influencing observed treatment patterns. Full article

(This article belongs to the Special Issue Pathogenesis and Treatment Strategies in Multiple Myeloma: From Basic Research to Real Life: 2nd Edition)

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