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In recent years, the treatment of multiple myeloma (MM) has made great progress, but most patients will have relapse or drug resistance after multiple lines of treatment, and there is currently no cure
.
As an immune cell therapy, BCMA CAR-T therapy has shown good efficacy in the treatment of relapsed/refractory multiple myeloma (RRMM), and its application potential has been highly recognized by authoritative medical institutions at home and abroad
.
As one of the centers with the largest number of blood disease patients enrolled in CAR-T clinical trials in China, Lu Daopei Hospital has accumulated rich clinical experience
.
Yimaitong specially invited Lu Daopei's medical team to share two cases of RRMM who received BCMA CAR-T treatment
.
Case 1 was resistant to multi-line therapy, and had good effect after BCMA CAR-T treatment >>>>Basic information Male, 69 years old, Italian, was resistant to third-line chemotherapy after being diagnosed with multiple myeloma, and progressed after autologous stem cell transplantation.
He was admitted to hospital on April 22, 2021
.
>>>>October 2018 after diagnosis and treatment in other hospitals: "Multiple myeloma, λ light chain type" was diagnosed in an Italian hospital
.
VTD regimen (bortezomib + thalidomide + dexamethasone) was used for 6 cycles, during which fracture of the lateral third of the clavicle and peripheral neuropathy occurred
.
Received two autologous stem cell transplants in May 2019 and November 2019, respectively, and the efficacy evaluation: complete remission (CR), oral lenalidomide maintenance therapy
.
In August 2020, PET/CT examination was performed: new bone destruction occurred, and serum free light chains increased rapidly; bone marrow aspiration: indicated disease progression (PD); FISH examination: abnormal t(11; 14)
.
September 2020: 4 cycles of DVD regimen (daratumumab + bortezomib + dexamethasone), efficacy evaluation: PD
.
After changing the PCD regimen (pomalidomide + cyclophosphamide + dexamethasone) for 3 cycles, the symptoms of bone pain were not relieved, and the edema of both lower extremities aggravated after activity
.
>>>>Diagnosis and treatment process - BCMA CAR-T April 22, 2021: Referred to Hebei Yanda Lu Daopei Hospital for treatment, physical examination showed: severe edema of both lower extremities, back pain required pain medication maintenance, auxiliary examination showed: 24 Hourly urine protein quantitative detection: 202 (mg/d)↑; Serological examination: FLC-κ 1.
76mg/L, FLC-λ 416mg/L↑, κ/λ 0.
004 (0.
3-1.
56); Bone marrow examination: immature plasma cells 27%, and some express CD269 (BCMA, 50.
7%); PET/CT examination: multiple bone mineral density reductions, hypermetabolic tumor activity residues in the right ilium and ribs, and some bones with pathological fractures May 2021, After pretreatment with FC chemotherapy (fludarabine + cyclophosphamide), BCMA CAR-T cells were infused, and the patient's vital signs were stable after infusion, and no other obvious side effects occurred except for low fever
.
The edema of both lower extremities gradually subsided, and the physical condition gradually improved
.
>>>>Efficacy evaluation 1 month after BCMA CAR-T reinfusion, the test results showed: 24-hour urine protein quantitative detection: 50 (mg/d), which was significantly lower than that at admission; serological test: FLC-κ 4.
58mg /L, FLC-λ 0.
61mg/L; bone marrow examination: no obvious plasma cells were found
.
The efficacy evaluation result was CR, and the patient was discharged
.
Eight months after BCMA CAR-T reinfusion, the patient's physical condition was good, and the symptoms such as back pain and edema of both lower extremities completely disappeared
.
>>>>Case Summary This case shows that BCMA CAR-T has a good therapeutic effect for patients with multiple myeloma who are resistant to third-line and above treatment regimens and progress after autologous stem cell transplantation
.
Case 2 BCMA is not expressed, and BCMA is still beneficial after CAR-T treatment >>>>Basic information Female, due to drug resistance to third-line chemotherapy after diagnosis of multiple myeloma, and recurrence after autologous stem cell transplantation, on May 10, 2021 hospitalization
.
>>>>After 2018 in the diagnosis and treatment of the foreign hospital: the local hospital was diagnosed as "multiple myeloma IgD-λ type III A", and the first-line treatment plan based on bortezomib was given for 3 cycles, and the efficacy evaluation: CR
.
October 2018: Autologous stem cell transplantation as consolidation therapy, followed by oral lenalidomide maintenance therapy
.
April 2020: Disease recurrence, 7 cycles of second-line treatment, but poor efficacy
.
December 2020-April 2021: Daratumumab-based chemotherapy was performed, but bone marrow biopsy showed that malignant monoclonal plasma cells accounted for 21.
763%, blood free light chain λ 1470 mg/L, urine free light Chain λ 5330mg/L
.
>>>>Diagnosis and treatment process - BCMA CAR-T May 10, 2021: The patient was transferred to Lu Daopei Hospital for treatment due to weakness, body pain, and repeated fever
.
Auxiliary examination showed: PET/CT examination: soft tissue density in the bone marrow cavity of bilateral femur and bilateral tibia, increased metabolism, and tumor involvement was considered; bone marrow aspirate: malignant monoclonal plasma cells accounted for 60.
13% and did not express BCMA
.
The diagnosis was "multiple myeloma light chain λ type, ISS stage: stage III, R-ISS stage: stage III"
.
After full communication with the patients and their families, BCMA CAR-T therapy and FC chemotherapy pretreatment were planned
.
June 1, 2021: After infusion of BCMA CAR-T cells, the patient developed fever.
After active anti-infection and symptomatic and supportive treatment, the body temperature was gradually controlled
.
>>>>Efficacy evaluation On the 14th day after BCMA CAR-T reinfusion, no malignant monoclonal plasma cells were found in the bone puncture
.
On the 31st day after the reinfusion, the residual bone puncture was still negative
.
Recheck serum immunofixation electrophoresis was negative, serum free light chain λ was within the normal range, and serum M protein was negative
.
Efficacy assessment results were CR
.
More than 8 months after BCMA CAR-T reinfusion, the re-examination showed that the disease was still in CR state, and the patient's mental state was good
.
>>>>Case Summary This case shows that BCMA CAR-T cell therapy in patients with multiple myeloma with low expression or even no expression of BCMA is still hopeful to obtain better curative effect
.
Conclusion CAR-T cell immunotherapy targeting BCMA has shown good efficacy and controllable safety in clinical application, and it is a new treatment option for MM patients who are resistant to multi-line therapy, regardless of whether the patient is Expression of BCMA may benefit from it
.
BCMA CAR-T therapy is expected to benefit more patients with refractory and relapsed multiple myeloma in future clinical applications
.
Edit: Moon Typesetting: Wenting pokes "read the original text", we make progress together
.
As an immune cell therapy, BCMA CAR-T therapy has shown good efficacy in the treatment of relapsed/refractory multiple myeloma (RRMM), and its application potential has been highly recognized by authoritative medical institutions at home and abroad
.
As one of the centers with the largest number of blood disease patients enrolled in CAR-T clinical trials in China, Lu Daopei Hospital has accumulated rich clinical experience
.
Yimaitong specially invited Lu Daopei's medical team to share two cases of RRMM who received BCMA CAR-T treatment
.
Case 1 was resistant to multi-line therapy, and had good effect after BCMA CAR-T treatment >>>>Basic information Male, 69 years old, Italian, was resistant to third-line chemotherapy after being diagnosed with multiple myeloma, and progressed after autologous stem cell transplantation.
He was admitted to hospital on April 22, 2021
.
>>>>October 2018 after diagnosis and treatment in other hospitals: "Multiple myeloma, λ light chain type" was diagnosed in an Italian hospital
.
VTD regimen (bortezomib + thalidomide + dexamethasone) was used for 6 cycles, during which fracture of the lateral third of the clavicle and peripheral neuropathy occurred
.
Received two autologous stem cell transplants in May 2019 and November 2019, respectively, and the efficacy evaluation: complete remission (CR), oral lenalidomide maintenance therapy
.
In August 2020, PET/CT examination was performed: new bone destruction occurred, and serum free light chains increased rapidly; bone marrow aspiration: indicated disease progression (PD); FISH examination: abnormal t(11; 14)
.
September 2020: 4 cycles of DVD regimen (daratumumab + bortezomib + dexamethasone), efficacy evaluation: PD
.
After changing the PCD regimen (pomalidomide + cyclophosphamide + dexamethasone) for 3 cycles, the symptoms of bone pain were not relieved, and the edema of both lower extremities aggravated after activity
.
>>>>Diagnosis and treatment process - BCMA CAR-T April 22, 2021: Referred to Hebei Yanda Lu Daopei Hospital for treatment, physical examination showed: severe edema of both lower extremities, back pain required pain medication maintenance, auxiliary examination showed: 24 Hourly urine protein quantitative detection: 202 (mg/d)↑; Serological examination: FLC-κ 1.
76mg/L, FLC-λ 416mg/L↑, κ/λ 0.
004 (0.
3-1.
56); Bone marrow examination: immature plasma cells 27%, and some express CD269 (BCMA, 50.
7%); PET/CT examination: multiple bone mineral density reductions, hypermetabolic tumor activity residues in the right ilium and ribs, and some bones with pathological fractures May 2021, After pretreatment with FC chemotherapy (fludarabine + cyclophosphamide), BCMA CAR-T cells were infused, and the patient's vital signs were stable after infusion, and no other obvious side effects occurred except for low fever
.
The edema of both lower extremities gradually subsided, and the physical condition gradually improved
.
>>>>Efficacy evaluation 1 month after BCMA CAR-T reinfusion, the test results showed: 24-hour urine protein quantitative detection: 50 (mg/d), which was significantly lower than that at admission; serological test: FLC-κ 4.
58mg /L, FLC-λ 0.
61mg/L; bone marrow examination: no obvious plasma cells were found
.
The efficacy evaluation result was CR, and the patient was discharged
.
Eight months after BCMA CAR-T reinfusion, the patient's physical condition was good, and the symptoms such as back pain and edema of both lower extremities completely disappeared
.
>>>>Case Summary This case shows that BCMA CAR-T has a good therapeutic effect for patients with multiple myeloma who are resistant to third-line and above treatment regimens and progress after autologous stem cell transplantation
.
Case 2 BCMA is not expressed, and BCMA is still beneficial after CAR-T treatment >>>>Basic information Female, due to drug resistance to third-line chemotherapy after diagnosis of multiple myeloma, and recurrence after autologous stem cell transplantation, on May 10, 2021 hospitalization
.
>>>>After 2018 in the diagnosis and treatment of the foreign hospital: the local hospital was diagnosed as "multiple myeloma IgD-λ type III A", and the first-line treatment plan based on bortezomib was given for 3 cycles, and the efficacy evaluation: CR
.
October 2018: Autologous stem cell transplantation as consolidation therapy, followed by oral lenalidomide maintenance therapy
.
April 2020: Disease recurrence, 7 cycles of second-line treatment, but poor efficacy
.
December 2020-April 2021: Daratumumab-based chemotherapy was performed, but bone marrow biopsy showed that malignant monoclonal plasma cells accounted for 21.
763%, blood free light chain λ 1470 mg/L, urine free light Chain λ 5330mg/L
.
>>>>Diagnosis and treatment process - BCMA CAR-T May 10, 2021: The patient was transferred to Lu Daopei Hospital for treatment due to weakness, body pain, and repeated fever
.
Auxiliary examination showed: PET/CT examination: soft tissue density in the bone marrow cavity of bilateral femur and bilateral tibia, increased metabolism, and tumor involvement was considered; bone marrow aspirate: malignant monoclonal plasma cells accounted for 60.
13% and did not express BCMA
.
The diagnosis was "multiple myeloma light chain λ type, ISS stage: stage III, R-ISS stage: stage III"
.
After full communication with the patients and their families, BCMA CAR-T therapy and FC chemotherapy pretreatment were planned
.
June 1, 2021: After infusion of BCMA CAR-T cells, the patient developed fever.
After active anti-infection and symptomatic and supportive treatment, the body temperature was gradually controlled
.
>>>>Efficacy evaluation On the 14th day after BCMA CAR-T reinfusion, no malignant monoclonal plasma cells were found in the bone puncture
.
On the 31st day after the reinfusion, the residual bone puncture was still negative
.
Recheck serum immunofixation electrophoresis was negative, serum free light chain λ was within the normal range, and serum M protein was negative
.
Efficacy assessment results were CR
.
More than 8 months after BCMA CAR-T reinfusion, the re-examination showed that the disease was still in CR state, and the patient's mental state was good
.
>>>>Case Summary This case shows that BCMA CAR-T cell therapy in patients with multiple myeloma with low expression or even no expression of BCMA is still hopeful to obtain better curative effect
.
Conclusion CAR-T cell immunotherapy targeting BCMA has shown good efficacy and controllable safety in clinical application, and it is a new treatment option for MM patients who are resistant to multi-line therapy, regardless of whether the patient is Expression of BCMA may benefit from it
.
BCMA CAR-T therapy is expected to benefit more patients with refractory and relapsed multiple myeloma in future clinical applications
.
Edit: Moon Typesetting: Wenting pokes "read the original text", we make progress together
