Five-year remission without disease progression in a patient with relapsed/refractory multiple myeloma with extramedullary disease treated with LCAR-B38M chimeric antigen receptor T cells in the LEGEND-2study: a case report

Journal of Medical Case Reports

Case Report

Ai-Li He¹  Wan-Hong Zhao²  Yin-Xia Chen²  Yi-Lin Zhang²  Bo Lei²  Xing-Mei Cao²  Yun Yang²  Wang-Gang Zhang²  Jian-Li Wang²  Ju Bai²  Li-Li Wei²  Peng-Yu Zhang²  Xu-Geng Wang²  Jie Liu²  Liu-Fang Gu²  Rui-Li Zhang²  Bai-Yan Wang²  Yan Xu²  Frank Fan³  Qiu-Chuan Zhuang³  Fang-Xia Wang⁴ 

[1] Department of Hematology and National-Local Joint Engineering Research Center of Biodiagnostics & Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xincheng District, 710004, Xi’an, China;Nanjing Legend Biotech, Nanjing, China;The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China;

关键词: Multiple myeloma;    CAR-T;    BCMA;    Case study;    Extramedullary disease;   

DOI  :  10.1186/s13256-022-03636-9

 received in 2021-07-13, accepted in 2022-10-04,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundMultiple myeloma remains incurable despite treatment advancements over the last 20 years. LCAR-B38M Cells in Treating Relapsed/Refractory Multiple Myeloma was a phase 1, first-in-human, investigator-initiated study in relapsed/refractory multiple myeloma conducted at four sites in China. The study used LCAR-B38M chimeric antigen receptor-T cells expressing two B-cell maturation antigen-targeting single-domain antibodies designed to confer avidity, and a CD3ζ signaling domain with a 4-1BB costimulatory domain to optimize T-cell activation and proliferation. This chimeric antigen receptor construct is identical to ciltacabtagene autoleucel. In the LEGEND-2 study (n = 57, Xi’an site), overall response rate was 88%; median (95% CI) progression-free survival and overall survival were 19.9 (9.6–31.0) and 36.1 (26.4–not evaluable) months, respectively; and median follow-up was 25 months. This case study reports on a patient with relapsed/refractory multiple myeloma (λ light chain type) who was treated with LCAR-B38M chimeric antigen receptor T cells in the LEGEND-2 study (Xi’an site); he had received five prior lines of treatment and had extensive extramedullary lesions.Case presentationThe patient, a 56-year-old Asian male, received cyclophosphamide (500 mg daily × 3 days) as lymphodepletion therapy and a total dose of 0.5 × 106 chimeric antigen receptor + T cells/kg split into three infusions (days 1, 24, and 84 from June to August 2016). He experienced grade 2 cytokine release syndrome after the first infusion; all symptoms resolved with treatment. No cytokine release syndrome occurred following the second and third infusions. His λ light chain levels decreased and normalized 20 days after the first infusion, and extramedullary lesions were healed as of January 2018. He has sustained remission for 5 years and received no other multiple myeloma treatments after LCAR-B38M chimeric antigen receptor T cell infusion. As of 30 October 2020, the patient is still progression-free and has maintained minimal residual disease-negative (10–4) complete response status for 52 months.ConclusionsThis case provides support that treatment with LCAR-B38M chimeric antigen receptor T cells can result in long-term disease remission of 5 or more years without disease progression in a heavily pretreated patient with extensive extramedullary disease and no other treatment options.

【 授权许可】

CC BY   
© The Author(s) 2022

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