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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-2 study: a case report.

Authors :
Wang, Bai-Yan
Zhao, Wan-Hong
Chen, Yin-Xia
Cao, Xing-Mei
Yang, Yun
Zhang, Yi-Lin
Wang, Fang-Xia
Zhang, Peng-Yu
Lei, Bo
Gu, Liu-Fang
Wang, Jian-Li
Bai, Ju
Xu, Yan
Wang, Xu-Geng
Zhang, Rui-Li
Wei, Li-Li
Zhuang, Qiu-Chuan
Fan, Frank
Zhang, Wang-Gang
He, Ai-Li
Source :
Journal of Medical Case Reports; 12/11/2022, Vol. 16 Issue 1, p1-8, 8p
Publication Year :
2022

Abstract

Background: Multiple 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 presentation: The patient, a 56-year-old Asian male, received cyclophosphamide (500 mg daily × 3 days) as lymphodepletion therapy and a total dose of 0.5 × 10<superscript>6</superscript> 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<superscript>–4</superscript>) complete response status for 52 months. Conclusions: This 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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17521947
Volume :
16
Issue :
1
Database :
Complementary Index
Journal :
Journal of Medical Case Reports
Publication Type :
Academic Journal
Accession number :
160707731
Full Text :
https://doi.org/10.1186/s13256-022-03636-9