AUTHOR=Wang Ting , He Ting , Ma Lie , Yang Yazi , Feng Ru , Ding Yanping , Shan Yueming , Bu Bing , Qi Feifei , Wu Fei , Lu Xin-an , Liu Hui 

TITLE=Clinical Outcomes of BCMA CAR-T Cells in a Multiple Myeloma Patient With Central Nervous System Invasion

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.854448

DOI=10.3389/fonc.2022.854448

ISSN=2234-943X

ABSTRACT=Background: Multiple myeloma (MM) is the second most common hematological malignancy that still lacks effective clinical treatments. In particular, MM with central nervous system (CNS) invasion occurs rarely. Although B cell maturation antigen (BCMA)-targeted chimeric antigen receptor-T (CAR-T) cell therapy has shown great promise for the treatment of relapsed/refractory MM, few studies have reported whether BCMA CAR-T could inhibit MM with CNS invasion.
Case presentation: In this study, we report a special case of a 63-year-old male patient, who suffered MM with CNS invasion and presented rapid extramedullary disease (EMD) progression into multiple organs. Before CAR-T cell infusion, this patient received five cycles of bortezomib, adriamycin and dexamethasone (PAD) and an autologous transplant as the front-line treatment, followed by two cycles of bortezomib, lenalidomide, and dexamethasone (VRD) as the second-line regimen and daratumumab, bortezomib, dexamethasone (DVD) as the third-line regimen. Since the patient still showed rapid progressive disease (PD), BCMA CAR-T cells were infused and one month later, a stringent complete response (sCR) was achieved and the response lasted for four months. Meanwhile, only grade 1 cytokine release syndrome (CRS) was observed.
Conclusion: This case report demonstrated that BCMA CAR-T could effectively eradicate CNS-involved MM with low adverse events, suggesting that CAR-T cell therapy could be a feasible therapeutic option for this kind of refractory disease.
Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04537442
Keywords: CAR-T, BCMA, multiple myeloma, central nervous system, case report