A small but striking phase II trial called CAR-PRISM found that a single infusion of the CAR-T therapy cilta-cel (Carvykti) produced deep, lasting remissions in all 20 patients with high-risk smoldering multiple myeloma — a precursor condition that carries roughly a 50% chance of progressing to active myeloma within two years. Every patient achieved the lowest measurable level of minimal residual disease negativity within two months, and 90% had a complete or stringent complete response. Results were sustained over a median 15-month follow-up. Presented at the AACR annual meeting and published in Nature Medicine, these findings suggest that intervening early — before the immune system is compromised by active disease — may dramatically improve outcomes and potentially prevent myeloma from ever developing.
