CAR-T细胞治疗后复发/难治性多发性骨髓瘤患者的临床特征

Clinical characteristics of patients with relapsed/refractory multiple myeloma after CAR-T cell therapy

目的分析嵌合抗原受体T(chimeric antigen receptor,CAR-T)细胞治疗后复发/难治多发性骨髓瘤(relapsed/refractory multiple myeloma,RRMM)患者的临床特征,初步探索此类患者未来可能的治疗策略。方法以2020年1月至2024年6月在首都医科大学附属北京朝阳医院住院治疗的RRMM患者为研究对象,分析CAR-T细胞治疗后复发的临床特征及生存情况。结果共收集14例符合条件的RRMM患者,均接受靶向BCMA的CAR-T细胞治疗,中位无进展生存时间为17个月(范围:3~47个月)。疾病复发进展时,1例仅表现为髓外复发,2例继发浆细胞白血病,11例为髓内复发;7例检查细胞遗传学,其中4例患者存在1个高危基因,1例患者存在2个高危基因。首次挽救治疗中,常用药物包括达雷妥尤单抗(6例)、泊马度胺(5例)、卡非佐米(3例),3例患者入组临床试验。13例患者可评价疗效,总有效率为61.5%(8/13),其中完全缓解率为30.8%(4/13),非常好的部分缓解率为23.1%(3/13)。中位随访时间为15个月(范围:1~32个月),中位无进展生存时间为7个月。截至末次随访,死亡6例,中位总生存期为32个月;1例患者出现第二肿瘤,类型为肺癌。结论接受CAR-T细胞治疗后RRMM患者常见多类药物耐药,挽救治疗疗效及预后不佳。

Objective To analyze the clinical characteristics of patients with relapsed/refractory multiple myeloma(RRMM)after CAR-T cell therapy,and to explore the possible effective strategies for such patients in the future.Methods Patients with RRMM who were hospitalized in Beijing Chao-Yang Hospital,Capital Medical University from January 2020 to June 2024 were selected as the study subjects,and clinical characteristics and survival and survival after CAR-T cell therapy were analyzed.Results A total of 14 eligible RRMM patients who collected by the medical record system received CAR-T cell therapy targeting BCMA,with the median progression-free survival(PFS)of 17 months(range:3-47 months).At the time of disease recurrence and progression,1 patient had extramedullary relapse,2 patients developed secondary plasma cell leukemia,and 11 patients were intramedullay recurrence.Cytogenetics was examined in 7 patients,of which 4 patients with 1 high-risk gene,1 patient with two high-risk genes.In the first salvage regimens,the commonly used agents included Daratumumab(6 cases),Pomalidomide(5 cases),and Carfilzomib(3 cases),and 3 patients were enrolled in the clinical trials.Among the 13 evaluable patients,the overall response rate was 61.5%(8/13),with a complete response rate of 30.8%(4/13)and a very good partial response rate of 23.1%(3/13).The median follow-up time was 15 months(range:1-32 months),and the median PFS was 7 months.As of the last follow-up,6 patients died.The median overall survival was 32 months.1 patient developed a secondary malignance(lung cancer).Conclusions Patients with RRMM receiving CAR-T cell therapy have a poor response to the currently available agents at the time of relapse and progression.