About

Adam J. Waxman, MD, is an Assistant Professor of Clinical Medicine in the Hematology-Oncology department at the University of Pennsylvania's Perelman School of Medicine. He serves as an Attending at the Hospital of the University of Pennsylvania. Dr. Waxman completed his BA in Chemistry at New York University in 2007, earned his MD from Duke University School of Medicine in 2011, and is pursuing a MSCE in Clinical Epidemiology at the University of Pennsylvania, expected in 2025. His clinical expertise includes multiple myeloma, amyloidosis, monoclonal gammopathies, paraprotein-mediated renal disease, cryoglobulinemia, autologous stem cell transplantation, chronic lymphocytic leukemia, and indolent lymphomas. His research focuses on multiple myeloma and amyloidosis, particularly through clinical trials aimed at advancing treatment options for these conditions.

Research topics

• Immunology
• Medicine
• Internal medicine
• Computer Science
• Oncology
• Cancer research
• Dermatology
• Pathology
• Computational biology
• Biology
• Pharmacology

Selected publications

• CD4+ T cells mediate CAR-T cell-associated immune-related adverse events after BCMA CAR-T cell therapy

  Nature Medicine · 2026-01-15 · 2 citations

  articleOpen access
  PublisherOA PDFDOI

• Survival after Chimeric Antigen Receptor T-cell Therapy Is Predicted By Fried’s Frailty Phenotype

  Transplantation and Cellular Therapy · 2026-02-01

  article
  PublisherDOI

• Phase 2 Study of Cevostamab Consolidation Following BCMA CAR T Cell Therapy: Preliminary Safety and Efficacy Data from the “STEM” (Sequential T Cell-Engagement for Myeloma) Trial

  Clinical Lymphoma Myeloma & Leukemia · 2025-09-01

  article
  PublisherDOI

• Rebuilding immunity: Kinetics and clinical impact of immune reconstitution after CAR T-cell therapy in multiple myeloma

  Blood · 2025-11-03

  articleOpen access

  Abstract Introduction: Chimeric antigen receptor T-cell (CART) therapy frequently results in profound B- and T-cell depletion. The dynamics and clinical implications of immune reconstitution (IR) post-CART in multiple myeloma (MM) remain understudied. Methods Single-center retrospective study of 198 MM patients (pts) treated with ide-cel (n=73) or cilta-cel (n=125) between June 2021 and December 2024. Median follow-up was 20.5 months (mo) (ide-cel 30.6 vs cilta-cel 14.1). We analyzed the kinetics of T-cell and immunoglobulin subsets, excluding values after disease progression, and assessed their association with efficacy outcomes, treatment-related toxicities, and infections. Pts who initiated maintenance therapy were censored at the time of maintenance initiation. Kaplan–Meier analyses were used to assess treatment response and survival outcomes. Results This heavily pretreated cohort included 73.7% and 24.7% of pts with triple-refractory and penta-refractory MM, respectively; 18.7% had high-risk cytogenetics. Lymphocyte expansion kinetics differed based on product. In ide-cel-pts the absolute lymphocyte count (ALC) peaked at Day (D) 7 (300 vs 100 cells/μL), whereas cilta-cel peaked at D12 (450 vs 1100 cells/μL) and demonstrated a delayed but greater sustained expansion from D10 to D24 (AUC ide-cel 7,100 vs cilta-cel 11,400; p<0.01; bootstrap 95% CI [–7.6, –1.6]) despite comparable CD4⁺ and CD8⁺ T-cell proportions at apheresis between products (p>0.05). Among ide-cel–pts, a higher CD4⁺ proportion at apheresis trended toward longer PFS, exceeding the product-specific median (p=0.08), while no such association was observed in the cilta-cel group (p>0.5). Profound immunodeficiency at Month (M) 1, defined as CD4⁺ T-cell counts <50/μL, was associated with a significantly shorter PFS (3.2 vs 22.4 mo, p<0.0001). Median CD4⁺ T-cell count recovery (>150 cells/μL) occurred by M6, coinciding with the median time of Trimethoprim/Sulfamethoxazole exposure (5.6 mo [IQR 1.6–10.7]). To assess humoral immune reconstitution, IgM levels were analyzed, excluding pts with IgM-secreting myeloma and censoring those at time of progression. Ide-cel was associated with earlier immunoglobulin recovery (median IgM≠0), typically by M6 (Median IgM: ide-cel 13 mg/dl [IQR: 0-30.5] vs cilta-cel 0 [IQR: 0-19.5], p=0.06), compared to Year (Y) 1 (Median IgM: ide-cel 37 mg/dl [IQR: 21-56] vs cilta-cel 17.5 [IQR: 0-46.8], p=0.02). IgM levels were also significantly higher in ide-cel recipients at M3 (p<0.001). Immune reconstitution was associated with non-M-Spike bands in 20% of pts (12/61 with detectable IgM at M6). Among ide-cel–pts, higher detectable IgM levels at M3 were associated with inferior PFS (median IgM M3: 28 [PFS≤12 mo], 0 [PFS>12 mo], p=0.004). This association was not observed in cilta-cel-pts, likely related to immature follow-up. The infection rate in the cohort was 68.2% (135/198), with 54% resulting in hospitalizations. Median time to first infection was 1.9 mo [IQR: 0.6-4] with a trend toward earlier infection in cilta-cel (1.8 vs 2.5 mo, p=0.06). Pts with undetectable IgM at M3 who did not receive IVIG had a numerically higher risk of infection (72% vs 30%, p=0.15). These findings link prolonged immunoparesis to increased infection risk, supporting the use of IVIG. Indeed, 82.7% (158/191) of pts received IVIG, with a median initiation time of 1.8 mo post-CART. Among them, 47% discontinued IVIG by a median of 9.3 mo. Pts who received IVIG without evidence of immune reconstitution had similar infection and hospitalization rates as those with immune reconstitution (p>0.05 for each comparison). Conclusion: Immune profiling after CART therapy offers opportunities for risk stratification and intervention. A higher CD4⁺ T-cell proportion at apheresis may serve as a predictive biomarker for improved outcomes in ide-cel recipients, informing product selection or apheresis optimization strategies. Early CD4⁺ lymphopenia and rapid IgM recovery were associated with inferior PFS, suggesting that immune profiling at one month may help identify high-risk pts who could benefit from closer monitoring or early intervention. Cilta-cel induces delayed but more durable expansion, contributing to prolonged immunoparesis. The high incidence of infections, particularly among pts with persistent immune deficits and absent IgM, highlights the need for careful monitoring and infectious prophylaxis ie. use of IVIG to mitigate infection-related morbidity.

  PublisherOA PDFDOI

• Fried's frailty phenotype predicts survival in pts with relapsed/refractory lymphoma or myeloma undergoing chimeric antigen receptor T-cell therapy – a prospective, observational Study

  Blood · 2025-11-03

  articleOpen access

  Abstract Chimeric antigen T-cell receptor (CART) therapy is highly effective for pts (pts) with relapsed/refractory (R/R) lymphoma/multiple myeloma (MM). However, due to concerns regarding tolerability, older pts are underrepresented in CART trials and real-world studies indicate that CART is underutilized in older adults. Methods to assess fitness for CART are ECOG, clinician gestalt and age. There is interest in improving risk stratification of older adults using objective measures. Fried's frailty phenotype (FP) uses subjective (exhaustion, reported weight loss, activity level) and objective (gait speed, grip strength) measures to categorize pts into fit, pre-frail, and frail. We have previously shown that FP predicts for overall survival (OS) in older stem cell transplant (SCT) recipients. We hypothesize that FP will be associated with progression-free survival (PFS) and OS in older pts with lymphoma/MM undergoing CART therapy. We prospectively enrolled pts ≥ 60 years planned for CART for R/R lymphoma/MM from May 2019 – 2023 on a clinical trial. We performed FP prior to CART infusion, and at 7 days (d), 14d, 21d, 1 month (mo), 3mo, 6mo and 12mo post-infusion. 36 pts were enrolled with a median age at CART infusion of 69 years (Range 60-81). 53% of pts had MM, of whom 63% had intermediate or high-risk disease by R-ISS. The remainder had lymphoma (diffuse large B-cell or follicular lymphoma) with IPI > 2 at diagnosis in 59%. Idecagtagene vicleucel and tisagenlecleucel were the most frequently administered CART products. Median follow up was 33mo. Median prior lines of therapy (LOT) was 3 (Range 1-7) and 47% had prior auto-SCT. Pre-infusion, majority had low ECOG scores (0-1, 81%), including 71% categorized as frail by FP. At pre-infusion FP, 35% of pts were fit (score 0), 44% were prefrail (score 1-2) and 21% were frail (score 3-5). Frail pts were more likely to be admitted for >7d for their CART infusion (OR 7.0, 95% CI 1.02-47.97, p=0.04). Frailty was not associated with risk of CRS, ICANS or 30-day hospital readmission. 13 pts had died by the time of analysis; all but 2 deaths were related to progressive disease. 2 non-disease related deaths were 1 death from COVID and 1 ICANS-related death from teclistamab after relapse 1 year and 2 years after infusion, respectively. At Day 21 post-infusion, 21% were fit, 57% were prefrail, and 21% were frail. At 1mo post-infusion, 25% were fit, 63% were prefrail, and 13% were frail. Being frail by FP at pre-infusion (p<0.001), Day 21 (p=0.03) or 1 month (p=0.009) post-infusion was associated with inferior OS from that time point. Median PFS in pre-infusion fit, prefrail, and frail pts were 23.4mo (95% CI 17.1-NR), 18.4mo (95% CI 6.8-13.8) and 4.0mo (95% CI 2.5-8.4), respectively. 2-year OS estimates were 100%, 93% and 14%, in fit, prefrail and frail pts respectively. 14 of 36 pts maintained or improved their FP from pre-infusion to 1mo; all but 3 received physical therapy (PT) while in hospital with 5 pts continuing PT outpatient. Notably, pts who maintained or improved their FP from pre-infusion to 1mo post-infusion had significantly better OS (p=0.05) than pts who had declines in their scores. Along with pre-infusion, day 21 and 1mo post-infusion FP scores, LDH (Mean 182 U/L) at the time of CART infusion was significantly associated with OS in the univariate Cox proportional hazards model (HR 5.22, 95% CI 1.43-19.18, p=0.013). Several factors including disease type, number of prior lines of therapy, use of bridging, stage at CART, IPI/RISS at diagnosis, HCT-CI, ECOG, presence of extra-nodal disease, CRS, ICANS, gender, age by decade, and BMI did not correlate with outcome. In pts ≥ 60 with R/R lymphoma/MM undergoing CART, 21% were frail by FP prior to CART. Frailty by FP pre-infusion, day 21 and 1mo post-infusion was associated with inferior OS as opposed to ECOG, HCT-CI, age or several disease related risk factors. FP may improve risk stratification in older adults undergoing CART. Pts with improvement in FP within 1mo post-infusion also had better outcomes. While better disease control could contribute to improved FP scores, most pts received PT to reverse frailty. Our future work aims to implement an exercise regimen to improve outcomes and to determine whether frailty is associated with adverse disease biology. Future work to uncover biologic mechanisms of frailty and adverse disease biology may identify novel targets for intervention to improve outcomes for frail pts.

  PublisherOA PDFDOI

• Disease response at apheresis and association with long-term outcomes following CAR-T cells for relapsed/refractory multiple myeloma (RRMM).

  Journal of Clinical Oncology · 2025-05-28

  article

  7518 Background: The two approved BCMA-targeted CAR-T products, cilta-cel and ide-cel, have significant efficacy in RRMM, but are not considered curative. Initial studies in ≥4 th line RRMM required progressive disease (PD) at time of enrollment and T cell apheresis. We hypothesized that using CAR-T cells as a planned consolidation strategy (i.e. in patients (pts) with stable or responsive disease on their current therapy) may lead to lower toxicity and better long-term disease control. Methods: We conducted a retrospective review of all RRMM pts receiving commercial CAR-T cells at the University of Pennsylvania from 6/1/21 to 4/30/24, with at least 6 months of follow-up. Intent for consolidation was retroactively assigned by chart review. Kaplan-Meier methodology was used to determine PFS and OS. Results: We identified 149 pts for analysis, with a median follow-up of 14.4 months (mos). Median prior lines was 6 and 81% of pts were triple class-refractory; 46% had high-risk cytogenetics, 26% had extramedullary disease, and 17% had prior BCMA-directed therapy. Pts received either cilta-cel (54%) or ide-cel (46%), and 95% received bridging therapy. CAR-T cells were intended as planned consolidation in 51 pts (34%); of these, 36 (71%) had ≥PR at time of apheresis. For consolidation vs non-consolidation groups, this translated into greater depth of response post-CAR-T cells (≥VGPR, 86% vs. 66%, p=0.01), lower rates of ≥grade 3 CRS (1.9% vs. 9.1%, p=0.16), and longer PFS (median not reached vs. 10 mos, p=0.001), respectively. The PFS improvement was seen for both cilta-cel (p=0.01) and ide-cel (p=0.04). No differences in neurotoxicity were noted. We also performed analyses based on response at apheresis, regardless of intent (8% ≥VGPR, 23% PR, 27% stable disease (SD), and 42% PD). PFS at 20 mos was 88%, 47%, 55%, and 31% for ≥VGPR, PR, SD, and PD at apheresis, respectively (p=0.015). Median PFS of pts with at least SD (≥SD) at apheresis was not reached vs. 9.4 mos in those with PD (p= 0.003), with 20-month OS of 87% in the ≥SD group and 68% in the PD group (p=0.015). Subgroup analysis confirmed this PFS difference for both cilta-cel and ide-cel, while the OS impact was only seen for cilta-cel. On multivariate analysis, having ≥SD at apheresis was an independent predictor for PFS. No statistically significant differences in CRS and ICANS were observed based on response at apheresis. Pts with ≥SD at apheresis had higher absolute lymphocyte counts at days 7 and 14 post-CAR-T infusion than those with PD, indicating disease status at apheresis may be associated with CAR-T product quality. Conclusions: Our data suggest that disease control (≥SD) at time of T-cell collection is associated with more durable responses, supporting use of CAR-T cells as a consolidation strategy in RRMM. We cannot conclude these associations are causal. Further analyses of apheresed T cell characteristics are planned.

  PublisherDOI

• PO-06-152 LONG TERM ARRHYTHMIA RISK AND CARDIOVASCULAR EVENTS IN HEMATOPOIETIC CELL TRANSPLANT SURVIVORS REVEAL LINQ CANCER REGISTRY (ARCHER): A PROSPECTIVE CLINICAL COHORT TRIAL

  Heart Rhythm · 2025-04-01

  articleOpen access
  PublisherOA PDFDOI

• Supplementary Tables and Figures from Anti-BCMA/CD19 CAR T Cells with Early Immunomodulatory Maintenance for Multiple Myeloma Responding to Initial or Later-Line Therapy

  2025-11-24

  articleOpen access

  <p>Supplemental tables: (1) Subject characteristics. (2) Cytogenetic profiles and high-risk features. (3) Prior treatment exposures and refractoriness. (4) CAR T cell product characteristics. (5) Products that did not meet target dose. (6) Adverse events of grade 3-4. (7) Cytokine release syndrome and ICANS. (8). Maintenance therapy. Supplemental Figures: (1) Study schematic and subject disposition, (2) Correlates of manufacturing success, (3) Hematopoietic recovery, (4) Post-infusion T cell phenotypes, (5) Correlates of in vivo expansion and manufacturing success, (6) Late post-infusion CAR T cell re-expansion, (7) Soluble BCMA, (8) Late-onset clinical responses, (9) MM cell BCMA expression, (10) Pre- and post-treatment Sox2-specific T cell responses in CART-BCMA monotherapy patients, (11) Pre- and post-treatment Sox2-specific T cell responses in CART-BCMA + huCART19 combination therapy patients, (12) Sustained post-treatment SOX2-specific T-cell responses.</p>

  PublisherDOI

• Access and outcomes of racial and ethnic minority populations receiving commercial anti-BCMA CART for myeloma

  Blood Immunology & Cellular Therapy · 2025-07-16 · 4 citations

  articleOpen access

  • REMPs have reduced access to CART-BCMA therapies for MM. • Clinical outcomes of both approved CART-BCMA products are comparable between REMP and non-REMP patients, despite disparities in access. Chimeric antigen receptor T-cell (CART) therapy targeting B-cell maturation antigen (CART-BCMA) is a transformative treatment for multiple myeloma (MM). However, its high cost and the need for specialized centers may limit access for racial and ethnic minority populations (REMPs), who are more affected by MM. This retrospective cohort study evaluated access and outcomes according to REMP status for 140 patients treated with CART-BCMA for MM (June 2021 to February 2024) at the Abramson Cancer Center (ACC) of the University of Pennsylvania. These patients were compared to 3 control cohorts: 3298 patients with MM from the ACC catchment area; 288 patients with MM treated at the ACC (ACC MM cohort); and 115 patients with MM who would have been eligible for CART (ACC MM CART-eligible cohort). The proportion of REMPs declined across cohorts (catchment area, 33.9%; ACC MM cohort, 28.1%; ACC MM CART-eligible cohort, 26.1%; CART cohort, 17.1%; P < .05). REMP patients receiving CART-BCMA were more likely to live closer to the ACC and were less likely to be married compared to non-REMP patients ( P < .05). Nevertheless, clinical outcomes were similar, with comparable rates of very good partial response (REMP, 75%; non-REMP, 72%; P = .47), progression-free survival ( P = .30), and overall survival ( P = .73), both in the whole cohort and in subgroup analyses based on the product used. Similarly, safety profiles showed no significant differences in cytokine release syndrome, neurotoxicity, and long-term hematologic toxicities. In conclusion, REMPs have reduced access to CART-BCMA but show similar clinical outcomes with both approved CART-BCMA products, highlighting the need to improve equity in access.

  PublisherDOI

• Nontuberculous mycobacterial infections following teclistamab in multiple myeloma

  Haematologica · 2025-02-06

  articleOpen access

  Not available.

  PublisherOA PDFDOI

Frequent coauthors

• Alfred L. Garfall

  University of Pennsylvania

  54 shared

• Dan T. Vogl

  Hospital of the University of Pennsylvania

  54 shared

• Adam D. Cohen

  University of Pennsylvania

  52 shared

• Edward A. Stadtmauer

  University of Pennsylvania

  52 shared

• Brendan M. Weiss

  39 shared

• Sandra Susanibar‐Adaniya

  26 shared

• Ola Landgren

  19 shared

• Joseph R. Carver

  University of Pennsylvania

  17 shared

Education

• B.A., Chemistry

  New York University

  2007

• M.D.

  Duke University School of Medicine

  2011

• Other, Clinical Epidemiology

  University of Pennsylvania

  2025