Long-term follow-up of BCMA CAR-T cell therapy in patients with relapsed/refractory multiple myeloma.

IF 10.3 1区 医学 Q1 IMMUNOLOGY
Chunxiang Jin, Rongrong Chen, Shan Fu, Mingming Zhang, Yuanyin Teng, Tingting Yang, Fengmei Song, Jingjing Feng, Ruimin Hong, Jiazhen Cui, Simao Huang, Huijun Xu, Yanlei Zhang, Guoqing Wei, Zhen Cai, Yok-Lam Kwong, Thomas Sau Yan Chan, Alex H Chang, He Huang, Yongxian Hu
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引用次数: 0

Abstract

Background: B-cell maturation antigen (BCMA)-targeting chimeric antigen receptor (CAR) T-cell immunotherapy has shown promising results in the treatment of relapsed or refractory multiple myeloma (R/RMM). This study presents the updated long-term outcomes from our center.

Methods: Between July 30, 2018, and September 27, 2023, 141 patients with R/RMM who received BCMA CAR-T therapy were enrolled. Patients underwent conditioning chemotherapy with cyclophosphamide and fludarabine, followed by BCMA CAR-T cell infusion at a median dose of 2.36×106 cells/kg. The study evaluated overall response rates, long-term efficacy, safety profiles, and their associations with clinical and disease characteristics.

Results: At a median follow-up of 20.2 months, the safety profile of the therapy was manageable. Grade 3/4 cytokine release syndrome occurred in 36.2% of patients, with no cases of severe neurotoxicity reported. 1-month post-infusion, grade ≥3 anemia persisted in 39.6% of patients, while neutropenia (43.3%) and thrombocytopenia (52.2%) were observed. The objective response rate (ORR) among evaluable patients was 94.8%, with 50.7% achieving a complete response (CR). The 4-year progression-free survival and overall survival rates were 37.4% (95% CI, 29.1% to 48.1%) and 63.2% (95% CI, 54.8% to 72.8%), respectively, with survival curves showing gradual flattening over time. Patients with a history of autologous stem cell transplantation (ASCT) and those with extramedullary disease demonstrated significantly inferior efficacy and survival outcomes. Peak CAR-T cell expansion was positively correlated with ORR (p<0.001) and CR (p<0.001). Notably, patients with prior ASCT exhibited significantly lower CAR-T cell expansion compared with those without prior ASCT (p<0.001). Immunophenotypic analysis of infused CAR-T cells demonstrated impaired fitness in patients who received ASCT in the past year.

Conclusions: BCMA CAR-T therapy in patients with R/RMM results in significant and sustained responses, with a manageable safety profile on a large scale. Prior ASCT and extramedullary disease represent adverse prognostic factors. Patients with a history of ASCT demonstrate limited peak CAR-T cell expansion.

BCMA CAR-T细胞治疗复发/难治性多发性骨髓瘤患者的长期随访
背景:b细胞成熟抗原(BCMA)靶向嵌合抗原受体(CAR) t细胞免疫疗法在治疗复发或难治性多发性骨髓瘤(R/RMM)方面显示出良好的效果。本研究展示了我们中心最新的长期结果。方法:2018年7月30日至2023年9月27日,141例接受BCMA CAR-T治疗的R/RMM患者入组。患者接受环磷酰胺和氟达拉滨调节性化疗,随后以2.36×106细胞/kg的中位剂量输注BCMA CAR-T细胞。该研究评估了总体缓解率、长期疗效、安全性及其与临床和疾病特征的关系。结果:在中位20.2个月的随访中,该疗法的安全性是可控的。36.2%的患者出现3/4级细胞因子释放综合征,无严重神经毒性病例报告。输注后1个月,39.6%的患者持续出现≥3级贫血,同时出现中性粒细胞减少(43.3%)和血小板减少(52.2%)。可评估患者的客观缓解率(ORR)为94.8%,其中50.7%达到完全缓解(CR)。4年无进展生存率和总生存率分别为37.4% (95% CI, 29.1% ~ 48.1%)和63.2% (95% CI, 54.8% ~ 72.8%),随着时间的推移,生存曲线逐渐趋于平缓。有自体干细胞移植(ASCT)病史的患者和髓外疾病患者的疗效和生存结果明显较差。CAR-T细胞扩增峰值与ORR呈正相关(结论:BCMA CAR-T治疗R/RMM患者可获得显著且持续的应答,且具有可管理的大规模安全性。既往ASCT和髓外疾病是不良预后因素。有ASCT病史的患者表现出有限的CAR-T细胞扩增峰值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal for Immunotherapy of Cancer
Journal for Immunotherapy of Cancer Biochemistry, Genetics and Molecular Biology-Molecular Medicine
CiteScore
17.70
自引率
4.60%
发文量
522
审稿时长
18 weeks
期刊介绍: The Journal for ImmunoTherapy of Cancer (JITC) is a peer-reviewed publication that promotes scientific exchange and deepens knowledge in the constantly evolving fields of tumor immunology and cancer immunotherapy. With an open access format, JITC encourages widespread access to its findings. The journal covers a wide range of topics, spanning from basic science to translational and clinical research. Key areas of interest include tumor-host interactions, the intricate tumor microenvironment, animal models, the identification of predictive and prognostic immune biomarkers, groundbreaking pharmaceutical and cellular therapies, innovative vaccines, combination immune-based treatments, and the study of immune-related toxicity.
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