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; Linqin Wang; Yifan Zeng; Ruimin Hong; Cheng Zu; Elaine Tan Su Yin; Houli Zhao; Guoqing Wei; Li Yang; Aiyun Jin; Yongxian Hu; He Huang

doi:10.3389/fonc.2021.755584

Successful BCMA CAR-T Therapy for Multiple Myeloma With Central Nervous System Involvement Manifesting as Cauda Equina Syndrome-A Wandering Road to Remission

Front Oncol. 2021 Nov 17:11:755584. doi: 10.3389/fonc.2021.755584. eCollection 2021.

Authors

Yiyun Wang^{1

2

3

4}, Linqin Wang^{1

2

3

4}, Yifan Zeng⁵, Ruimin Hong^{1

2

3

4}, Cheng Zu^{1

2

3

4}, Elaine Tan Su Yin^{1

2

3

4}, Houli Zhao^{1

2

3

4}, Guoqing Wei^{1

2

3

4}, Li Yang^{1

2

3

4}, Aiyun Jin^{1

2

3

4}, Yongxian Hu^{1

2

3

4}, He Huang^{1

2

3

4}

Affiliations

¹ Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Institute of Hematology, Zhejiang University, Hangzhou, China.
³ Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.
⁴ Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China.
⁵ Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

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: cauda equina syndrome; central nervous system; chimeric antigen receptor (CAR T); immunotherapy; multiple myeloma.