T cells expressing an anti–B-cell maturation antigen chimeric antigen receptor cause remissions of multiple myeloma

SA Ali, V Shi, I Maric, M Wang… - Blood, The Journal …, 2016 - ashpublications.org
SA Ali, V Shi, I Maric, M Wang, DF Stroncek, JJ Rose, JN Brudno, M Stetler-Stevenson
Blood, The Journal of the American Society of Hematology, 2016ashpublications.org
Therapies with novel mechanisms of action are needed for multiple myeloma (MM). B-cell
maturation antigen (BCMA) is expressed in most cases of MM. We conducted the first-in-
humans clinical trial of chimeric antigen receptor (CAR) T cells targeting BCMA. T cells
expressing the CAR used in this work (CAR-BCMA) specifically recognized BCMA-
expressing cells. Twelve patients received CAR-BCMA T cells in this dose-escalation trial.
Among the 6 patients treated on the lowest 2 dose levels, limited antimyeloma activity and …
Abstract
Therapies with novel mechanisms of action are needed for multiple myeloma (MM). B-cell maturation antigen (BCMA) is expressed in most cases of MM. We conducted the first-in-humans clinical trial of chimeric antigen receptor (CAR) T cells targeting BCMA. T cells expressing the CAR used in this work (CAR-BCMA) specifically recognized BCMA-expressing cells. Twelve patients received CAR-BCMA T cells in this dose-escalation trial. Among the 6 patients treated on the lowest 2 dose levels, limited antimyeloma activity and mild toxicity occurred. On the third dose level, 1 patient obtained a very good partial remission. Two patients were treated on the fourth dose level of 9 × 106 CAR+ T cells/kg body weight. Before treatment, the first patient on the fourth dose level had chemotherapy-resistant MM, making up 90% of bone marrow cells. After treatment, bone marrow plasma cells became undetectable by flow cytometry, and the patient’s MM entered a stringent complete remission that lasted for 17 weeks before relapse. The second patient on the fourth dose level had chemotherapy-resistant MM making up 80% of bone marrow cells before treatment. Twenty-eight weeks after this patient received CAR-BCMA T cells, bone marrow plasma cells were undetectable by flow cytometry, and the serum monoclonal protein had decreased by >95%. This patient is in an ongoing very good partial remission. Both patients treated on the fourth dose level had toxicity consistent with cytokine-release syndrome including fever, hypotension, and dyspnea. Both patients had prolonged cytopenias. Our findings demonstrate antimyeloma activity of CAR-BCMA T cells. This trial was registered to www.clinicaltrials.gov as #NCT02215967.
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