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

Blood. 2016 Sep 29;128(13):1688-700. doi: 10.1182/blood-2016-04-711903. Epub 2016 Jul 13.

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 × 10(6) 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.

Publication types

  • Case Reports
  • Clinical Trial, Phase I
  • Research Support, N.I.H., Intramural

MeSH terms

  • B-Cell Maturation Antigen / blood
  • B-Cell Maturation Antigen / immunology*
  • Bone Marrow / immunology
  • Bone Marrow / pathology
  • Cytokines / blood
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Immunotherapy, Adoptive / methods*
  • Leukopenia / etiology
  • Multiple Myeloma / blood
  • Multiple Myeloma / immunology*
  • Multiple Myeloma / therapy*
  • Myeloma Proteins / metabolism
  • Recombinant Fusion Proteins / blood
  • Recombinant Fusion Proteins / immunology
  • Remission Induction
  • T-Lymphocytes / immunology*
  • Thrombocytopenia / etiology
  • Tumor Burden / immunology

Substances

  • B-Cell Maturation Antigen
  • Cytokines
  • Myeloma Proteins
  • Recombinant Fusion Proteins
  • TNFRSF17 protein, human

Associated data

  • ClinicalTrials.gov/NCT02215967