A female patient from China was diagnosed as “multiple myeloma IgD-λ type III A” in 2018. The patient received a first-line treatment regimen based on bortezomib, and the efficacy evaluation was CR after 3 cycles. In October 2018 Monthly autologous hematopoietic stem cell transplantation was performed as consolidation therapy, followed by oral lenalidomide maintenance therapy. In April 2020, the disease relapsed, and the patient received 7 cycles of second-line treatment, but the efficacy was poor. From December 2020 to April 2021, the patient received daratumumab-based chemotherapy, but bone biopsy still showed that malignant monoclonal plasma cells accounted for 21.763%, blood free light chain λ 1470 mg/L, urine free light Chain λ 5330mg/L.
At this time, the patient has completed the all standard treatments and new drug treatment for myeloma that can be available in China, and has completed the autologous hematopoietic stem cell transplantation. There is no better treatment plan except entering the CAR-T clinical trial. After being recommended by local doctors, the patient was admitted to Lu Daopei Hospital on May 10, 2021, hoping to be enrolled in the clinical trial of BCMA CAR-T in the treatment of MM carried out by Lu Daopei Hospital. On admission, the patient was in a debilitated state, with generalized pain and recurrent fever. After perfecting various examinations, the diagnosis was “multiple myeloma light chain λ type, ISS stage: stage III, R-ISS stage: stage III, mSMART risk stratification: high-risk group”.
PET CT examination: soft tissue density in the bone marrow cavity of bilateral femur and bilateral tibia, increased metabolism, and tumor involvement was considered; bone biopsy showed that malignant monoclonal plasma cells accounted for 60.13% and did not express BCMA.
At present, the curative effect of multiple myeloma without BCMA expression, although the literature shows that it may be effective, but there is a lack of clear relevant data. The physician informed the patient and their family members of the situation truthfully. After careful consideration, the patient and their family members chose to try the relevant treatment plan.
The patient was infused with BCMA CAR-T cells on June 1, 2021 after pretreatment of FC. After the infusion, the patient had fever, and after active anti-infection and symptomatic and supportive treatment, the body temperature was gradually controlled. On the 14th day after infusion, no malignant monoclonal plasma cells were found in the biopsy. On the 31st day after the infusion, the patient’s biopsy was still negative. Recheck serum immunofixation electrophoresis was negative, serum free light chain λ was within the normal range, and serum M protein was negative. Indicates that the disease is in complete remission.
At present, It’s been more than 8 months since the patient was infused with BCMA CAR-T cells, and he is still in complete remission after returning to the hospital for a review.