Journal
FRONTIERS IN IMMUNOLOGY
Volume 12, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fimmu.2021.552429
Keywords
central nervous system involvement; multiple myeloma; chimeric antigen receptor T cell therpay; neurotoxicity; case report
Categories
Funding
- National Natural Science Foundation of China [81730003]
- National Science and Technology Major Project [2017ZX09304021]
- Science Planning Project of Suzhou [sys2018049]
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This is the first report of a patient with isolated CNS-MM treated using BCMA-CART therapy. The study showed that intravenously administered BCMA-CART cells trafficked into the cerebrospinal fluid, eradicated tumor cells, and induced severe but reversible neurological adverse events. This research suggests that BCMA-CART therapy can be considered as an alternative option for isolated CNS-MM.
Isolated central nervous system involvement in multiple myeloma (CNS-MM) is rare and carries extremely poor prognosis. Chimeric antigen receptor T cell therapy (CART) targeting B-cell maturation antigen (BCMA) is demonstrated as a promising strategy in MM treatment, but the clinical safety and efficacy of BCMA-CART against isolated CNS-MM remain elusive. Here we report on a 56-year-old male with refractory isolated CNS-MM who received autologous BCMA-CART therapy and developed grade 4 neurological complications. Cerebrospinal fluid (CSF) analyses showed significant expansion of CART cells and a substantially elevated interleukin-6 (IL-6) level. Intravenous methylprednisolone was administered and the symptoms resolved gradually. Unexpectedly, the level of IL-6 in the CSF was maintained for another 3 days even after the relief of the neurological symptoms. A partial response was achieved and sustained for 5.5 months. This is the first report describing a patient with isolated CNS-MM treated using BCMA-CART therapy. The results demonstrated that BCMA-CART cells administered intravenously trafficked into the CSF, eradicated tumor cells, and induced severe but reversible neurological adverse events. This single-patient report suggests that BCMA-CART therapy can be considered as an alternative option for isolated CNS-MM.
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