Frontiers in Oncology (Nov 2021)
Successful BCMA CAR-T Therapy for Multiple Myeloma With Central Nervous System Involvement Manifesting as Cauda Equina Syndrome—A Wandering Road to Remission
- Yiyun Wang,
- Yiyun Wang,
- Yiyun Wang,
- Yiyun Wang,
- Linqin Wang,
- Linqin Wang,
- Linqin Wang,
- Linqin Wang,
- Yifan Zeng,
- Ruimin Hong,
- Ruimin Hong,
- Ruimin Hong,
- Ruimin Hong,
- Cheng Zu,
- Cheng Zu,
- Cheng Zu,
- Cheng Zu,
- Elaine Tan Su Yin,
- Elaine Tan Su Yin,
- Elaine Tan Su Yin,
- Elaine Tan Su Yin,
- Houli Zhao,
- Houli Zhao,
- Houli Zhao,
- Houli Zhao,
- Guoqing Wei,
- Guoqing Wei,
- Guoqing Wei,
- Guoqing Wei,
- Li Yang,
- Li Yang,
- Li Yang,
- Li Yang,
- Aiyun Jin,
- Aiyun Jin,
- Aiyun Jin,
- Aiyun Jin,
- Yongxian Hu,
- Yongxian Hu,
- Yongxian Hu,
- Yongxian Hu,
- He Huang,
- He Huang,
- He Huang,
- He Huang
Affiliations
- Yiyun Wang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Yiyun Wang
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Yiyun Wang
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Yiyun Wang
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Linqin Wang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Linqin Wang
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Linqin Wang
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Linqin Wang
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Yifan Zeng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Ruimin Hong
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Ruimin Hong
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Ruimin Hong
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Ruimin Hong
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Cheng Zu
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cheng Zu
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Cheng Zu
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Cheng Zu
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Elaine Tan Su Yin
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Elaine Tan Su Yin
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Elaine Tan Su Yin
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Elaine Tan Su Yin
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Houli Zhao
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Houli Zhao
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Houli Zhao
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Houli Zhao
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Guoqing Wei
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Guoqing Wei
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Guoqing Wei
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Guoqing Wei
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Li Yang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Li Yang
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Li Yang
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Li Yang
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Aiyun Jin
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Aiyun Jin
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Aiyun Jin
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Aiyun Jin
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- Yongxian Hu
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Yongxian Hu
- Institute of Hematology, Zhejiang University, Hangzhou, China
- Yongxian Hu
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- Yongxian Hu
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- He Huang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- He Huang
- Institute of Hematology, Zhejiang University, Hangzhou, China
- He Huang
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
- He Huang
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
- DOI
- https://doi.org/10.3389/fonc.2021.755584
- Journal volume & issue
-
Vol. 11
Abstract
Multiple myeloma (MM) with central nervous system (CNS) involvement is rare with only 1% incidence. So far, there is no standard or effective treatment for CNS MM, and the expected survival time is fewer than 6 months. Here, we report a case of MM with CNS involvement presented with cauda equina syndrome (CES) who achieved complete remission after anti-B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR-T) cell therapy (Chictr.org.cn, ChiCTR1800017404). The expansion of BCMA CAR-T cells was observed in both peripheral blood (PB) and cerebrospinal fluid (CSF). The CAR-T cells peaked at 2.4 × 106/l in CSF at day 8 and 4.1 × 109/l in PB at day 13. The peak concentration of interleukin (IL)-6 in CSF was detected 3 days earlier, and almost five times higher than that in PB. Next, morphological analysis confirmed the elimination of nucleated cells in CSF 1 month after CAR-T cell treatment from 300 cells/μl, and the patient achieved functional recovery with regressed lesion shown in PET-CT. The case demonstrated that BCMA CAR-T cells are effective and safe in this patient population.
Keywords
- multiple myeloma
- central nervous system
- chimeric antigen receptor (CAR T)
- immunotherapy
- cauda equina syndrome
