Abecma for Multiple Myeloma: How It Works, What It Does, and More

Did you ever think we would see the day we could alter our bodies to fight cancer more effectively? It sounds like something you might see in a science fiction film. But thanks to immunotherapy medications like Abecma (idecabtagene vicleucel), it’s a possibility.

Abecma is a newer form of immunotherapy. It’s called chimeric antigen receptor (CAR) T-cell therapy. It trains your immune system to be better at finding and fighting cancer cells. The FDA approved Abecma in March 2021 as the first CAR T-cell therapy to treat a blood cancer called multiple myeloma.

CAR T-cell therapy is a more recent addition to the cancer world. Compared to traditional treatments, like chemotherapy, many people are less familiar with it. Knowing more about what to expect with Abecma can help you feel more comfortable when you and your healthcare team are deciding on your next treatment option.

What is Abecma?

Abecma is an immunotherapy medication that treats a type of blood cancer called multiple myeloma. It’s generally only considered after two or more cancer treatments have already been tried. These previous treatments should include an immunomodulatory medication like Revlimid (lenalidomide), a proteasome inhibitor like Velcade (bortezomib), and an anti-CD38 monoclonal antibody like Darzalex (daratumumab). 

What’s more, since Abecma is a CAR T-cell therapy medication, it’s also a type of gene therapy. This is because it works by using genetically-modified T cells that have learned to fight cancer more effectively. T cells are a type of white blood cell in your immune system that fight foreign invaders, such as cancer cells.

How does Abecma work for multiple myeloma?

Tumor cells are sneaky. All too often, they’re able to hide from your immune system. Abecma’s job is to help your immune system find these cancer cells more effectively. 

With Abecma, your T cells are genetically modified so they express CAR proteins. When T cells have CAR proteins on them, they’re better at recognizing specific targets on cancer cells and destroying them. These targets are called B-cell maturation antigen (BCMA). BCMA is frequently found on multiple myeloma cells. 

By targeting BCMA on cancer cells, Abecma helps your immune system fight multiple myeloma more effectively.

What does the CAR T-cell process look like?

Receiving Abecma is a multi-step process.

First, your blood is collected through a process called leukapheresis. Your blood goes through a machine that filters out T cells, and the machine returns the rest of your blood back to you. This process usually takes 2 to 6 hours.

Your collected T cells are then sent to a lab. Here, your T cells are modified to display CAR proteins that target multiple myeloma cells. Your transformed T cells are multiplied so that there are enough of them to fight your cancer. This process usually takes about 4 weeks.

Once your Abecma dose is made, the lab ships it back to your cancer care team so they can give it to you.

How is Abecma given when treating multiple myeloma?

Abecma is a one-time medication that’s infused into a vein. It usually takes about 30 minutes to infuse Abecma into your body. This can be longer if you have a larger dose that comes in multiple bags. Each bag takes about 30 minutes. 

Before you get your dose, though, there are a few steps to prepare your body for the medication. 

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The first step is to receive a low-dose chemotherapy regimen that kills leftover T cells in your body. You’ll get two chemotherapy medications — cyclophosphamide and fludarabine — once a day for 3 days. This is completed about 2 days before you receive Abecma; this process gives Abecma a better chance at being successful.

To prevent infusion reactions, you’ll also receive medications such as acetaminophen (Tylenol) and diphenhydramine (Benadryl) shortly before your Abecma infusion. 

What are the potential side effects of Abecma?

Abecma often causes a condition called cytokine release syndrome (CRS). Inflammation is a normal part of your immune system’s response in fighting tumor cells. However, in CRS, this response can be over exaggerated and also affect healthy cells. Symptoms of CRS range from mild to severe and may include fever, low blood pressure, and an elevated heart rate, among other effects.

Other Abecma side effects are also possible. These may include:

• Muscle or joint pain

• Diarrhea

• Nausea

• Smaller appetite than normal

• Swelling

• Cough

• Infection

• Fatigue

• Low white blood cells

• Low red blood cells

• Low platelets

Serious side effects

Abecma has a few boxed warnings, which is the most serious type of warning that the FDA can give to a medication.

CRS, and its related complications, have boxed warnings. CRS symptoms can sometimes become severe and can overlap with a condition called hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS). This is another syndrome that occurs when the immune system overreacts and attacks normal cells. HLH/MAS is rare, but it can occur as a result of ongoing or worsening CRS. Possible issues include:

• Low blood pressure

• Low oxygen levels

• Multiple organ dysfunction

• Kidney problems

• Low blood counts

Abecma also has a boxed warning for neurotoxicities. Possible symptoms include:

• Encephalopathy, including symptoms like memory loss, confusion, and difficulty with understanding

• Tremor

• Inability to speak

• Seizures

Another boxed warning is for prolonged cytopenias. This means it may take longer than normal for your blood counts to return to normal. Blood counts include your white blood cells, platelets, and red blood cells. 

These symptoms are rare, but they can be life-threatening if not managed appropriately. For this reason, you will be closely monitored for at least 4 weeks after your Abecma infusion and will need to stay close to your healthcare facility. You also shouldn’t drive or do tasks that require mental alertness for 8 weeks after your infusion.

How effective is Abecma when treating multiple myeloma?

An effective cancer treatment is hard to broadly define. Many factors influence which medication(s) would be most effective for you. Still, clinical trials help paint a picture about how effective Abemca is.

Abecma was initially studied in about 250 adults with relapsed or refractory multiple myeloma. Relapsed multiple myeloma means the cancer returned after initially improving or going away with previous treatment. Refractory means that the previous cancer treatment stopped working.

In the study, the overall response rate about 1 year after receiving Abecma was about 71%. This means that 71% of people who received Abecma saw signs of some or all of their cancer go away after about 1 year. Of these people, about 39% had a complete response or better — meaning they saw all or nearly all signs of their cancer go away.

Abecma may also be an effective treatment option for people with relapsed or refractory multiple myeloma that’s affecting their central nervous system (CNS). A small European study found that about 70% of people who received Abecma had no recurrence of multiple myeloma in the CNS after about 5 months.

How to save on Abecma

Without health insurance or financial assistance, Abecma has a high price tag. But there are ways you can save.

Abecma may be covered under your medical benefit if you have insurance. But if your insurance doesn’t cover Abecma, you have other financial assistance options. The manufacturer of Abecma has a program called Cell Therapy 360 that can help you navigate your options. For more information and to see if you’re eligible, call 1-888-805-4555 or visit Cell Therapy 360 online.

In addition, organizations like the Patient Access Network (PAN) Foundation and the HealthWell Foundation Copay Program often have grants for financial assistance for those who qualify. 

What are some alternatives to Abecma?

If you have relapsed or refractory multiple myeloma and need an Abecma alternative, you have several treatments to consider. One option is Carvykti (ciltacabtagene autoleucel). It’s the second CAR T-cell therapy approved for relapsed/refractory multiple myeloma. 

Medications that aren’t CAR T-cell therapies are also available. One example is Tecvayli (teclistamab), a bispecific T-cell engager. Like Abecma, it attaches to BCMA on multiple myeloma cells. But it attaches to T cells at the same time. This helps T cells in your immune system recognize and destroy multiple myeloma cells without having to make any genetic changes to them. Your cancer specialist can tell you if Abecma, Carvykti, Tecvayli, or another medication may be appropriate for your situation.

However, all of these treatments require healthcare facilities to be enrolled in a Risk Evaluation and Mitigation Strategy (REMS) medication safety program. This is due to the potentially severe side effects they can cause. 

Why trust our experts?

Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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