Clinical Advances

Advances in BCMA⁃CAR⁃T therapy of multiple myeloma and management after relapse

  • Sijia YAN ,
  • Yi XIAO
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  • Department of Hematology,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,Hubei,China

Received date: 2024-12-10

  Online published: 2025-04-23

Abstract

Multiple myeloma (MM) is a prevalent hematological malignancy. Despite the availability of various therapeutic agents, disease relapse remains inevitable. In recent years, B cell maturation antigen (BCMA)?targeted chimeric antigen receptor T (CAR?T) cell therapy has demonstrated remarkable success in treating relapsed/refractory (R/R) MM, offering new hope for RRMM patients. Currently, four types of BCMA?CAR?T products are available on the global market, and their application in RRMM is becoming increasingly widespread. However, RRMM patients who receive BCMA?CAR?T treatment still exhibit a high relapse rate. Research on maintenance therapy following BCMA?CAR?T treatment is currently limited, and multiple strategies exist for managing post?relapse RRMM after BCMA?CAR?T therapy.

Cite this article

Sijia YAN , Yi XIAO . Advances in BCMA⁃CAR⁃T therapy of multiple myeloma and management after relapse[J]. The Journal of Practical Medicine, 2025 , 41(7) : 929 -935 . DOI: 10.3969/j.issn.1006-5725.2025.07.001

References

1 FIRTH J. Haematology: multiple myeloma[J]. Clin Med (Lond),2019,19(1):58-60. doi:10.7861/clinmedicine.19-1-58
2 KAZANDJIAN D. Multiple myeloma epidemiology and survival: A unique malignancy[J]. Semin Oncol, 2016,43(6):676-681. doi:10.1053/j.seminoncol.2016.11.004
3 LEE L, BOUNDS D, HERLEDAN G, et al. Evaluation of B cell maturation antigen as a target for antibody drug conjugate mediated cytotoxicity in multiple myeloma[J]. Br J Haematol, 2016,174(6):911-922. doi:10.1111/bjh.14145
4 POORNIMA S, BINDU K, BINDU G, et al. FDA Approval Summary: Idecabtagene Vicleucel for Relapsed or Refractory Multiple Myeloma[J]. Clin Cancer Res, 2022,28(9):1759-1764. doi:10.1158/1078-0432.ccr-21-3803
5 KAVITA N, MEGHA K, BINDU G, et al. FDA Approval Summary: Ciltacabtagene Autoleucel for Relapsed or Refractory Multiple Myeloma[J]. Clin Cancer Res, 2024,30(14):2865-2871. doi:10.1158/1078-0432.ccr-24-0378
6 KEAM S J. Equecabtagene Autoleucel: First Approval[J]. Mol Diagn Ther, 2023,27(6):781-787. doi:10.1007/s40291-023-00673-y
7 LIN Y, RAJE N S, BERDEJA J G, et al. Idecabtagene vicleucel for relapsed and refractory multiple myeloma: Post hoc 18-month follow-up of a phase 1 trial[J]. Nat Med, 2023,29(9):2286-2294. doi:10.1038/s41591-023-02496-0
8 MUNSHI N C, ANDERSON L D, SHAH N, et al. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma[J]. N Engl J Med, 2021,384(8):705-716. doi:10.1056/nejmoa2024850
9 RODRIGUEZ-OTERO P, AILAWADHI S, ARNULF B, et al. Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma[J]. N Engl J Med, 2023,388(11):1002-1014. doi:10.1056/nejmoa2213614
10 MARTIN T, USMANI S Z, BERDEJA J G, et al. Ciltacabtagene Autoleucel, an Anti–B-cell Maturation Antigen Chimeric Antigen Receptor T-Cell Therapy, for Relapsed/Refractory Multiple Myeloma: CARTITUDE-1 2-Year Follow-Up[J]. J Clin Oncol, 2023,41(6):1265-1274. doi:10.1200/jco.22.00842
11 ZHAO W H, WANG B Y, CHEN L J, et al. Four-year follow-up of LCAR-B38M in relapsed or refractory multiple myeloma: A phase 1, single-arm, open-label, multicenter study in China (LEGEND-2)[J]. J Hematol Oncol, 2022,15(1):86. doi:10.1186/s13045-022-01301-8
12 MI J Q, ZHAO W, JING H, et al. Phase II, Open-Label Study of Ciltacabtagene Autoleucel, an Anti-B-Cell Maturation Antigen Chimeric Antigen Receptor-T-Cell Therapy, in Chinese Patients With Relapsed/Refractory Multiple Myeloma (CARTIFAN-1)[J]. J Clin Oncol,2023,41(6):1275-1284. doi:10.1200/jco.22.00690
13 VAN DE DONK N W J C, MOUNZER A, ADAM D C, et al. Ciltacabtagene Autoleucel (Cilta-cel), a BCMA-Directed CAR-T Cell Therapy, in Patients with Multiple Myeloma (MM) and Early Relapse after Initial Therapy: CARTITUDE-2 Cohort B 18-Month Follow-up[J]. Blood, 2022,140 (): 7536-7537. doi:10.1182/blood-2022-159169
14 COHEN A, EINSELE H, DELFORGE M, et al. OAB-045: Updated clinical data and biological correlative analyses of ciltacabtagene autoleucel (cilta-cel) in lenalidomide-refractory multiple myeloma after 1–3 prior lines of therapy: CARTITUDE-2 Cohort A[J]. Clin Lymphoma Myeloma, 2022, 22: S27-S28. doi:10.1016/s2152-2650(22)00318-4
15 European Myeloma Network. A Phase 3 Randomized Study Comparing Daratumumab, Bortezomib, Lenalidomide and Dexamethasone (DVRd) Followed by Ciltacabtagene Autoleucel Versus Daratumumab, Bortezomib, Lenalidomide and Dexamethasone (DVRd) Followed by Autologous Stem Cell Transplant (ASCT) in Participants With Newly Diagnosed Multiple Myeloma Who Are Transplant Eligible: NCT05257083[R]. clinicaltrials.gov, 2023.
16 SAN-MIGUEL J, DHAKAL B, YONG K, et al. Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma[J]. N Engl J Med, 2023,389(4):335-347.
17 LI C, WANG D, FANG B, et al. Updated long-term follow-up results of a phase 1b/2 study (FUMANBA-1) in patients with relapsed/refractory multiple myeloma (RRMM) treated with equecabtagene autoleucel[J]. Clin Lymphoma Myeloma, 2023, 23: S196-S197. doi:10.1016/s2152-2650(23)01908-0
18 LI C, WANG D, SONG Y, et al. CT103A, a novel fully human BCMA-targeting CAR-T cells, in patients with relapsed/refractory multiple myeloma: Updated results of phase 1b/2 study (FUMANBA-1)[J]. J Clin Oncol, 2023, 41(): 8025-8025. doi:10.1200/jco.2023.41.16_suppl.8025
19 FU C. Three-Year Follow-up on Efficacy and Safety Results from Phase 1 Lummicar Study 1 of Zevorcabtagene Autoleucel in Chinese Patients with Relapsed or Refractory Multiple Myeloma[J].Blood, 2023, 142(): 4845. doi:10.1182/blood-2023-184373
20 CHEN W, FU C, FANG B, et al. Phase Ⅱ Study of Fully Human BCMA-Targeting CAR-T Cells (Zevorcabtagene Autoleucel) in Patients with Relapsed/Refractory Multiple Myeloma[J]. Blood, 2022, 140(): 4564-4565. doi:10.1182/blood-2022-168610
21 WANG Z, ZHOU G, RISU N, et al. Lenalidomide Enhances CAR-T Cell Activity Against Solid Tumor Cells[J]. Cell Transplantation, 2020, 29: 096368972092082. doi:10.1177/0963689720920825
22 GARFALL A L, COHEN A D, SUSANIBAR-ADANIYA S P, et al. Anti-BCMA/CD19 CAR T Cells with Early Immunomodulatory Maintenance for Multiple Myeloma Responding to Initial or Later-Line Therapy[J]. Blood Cancer Discov, 2023,4(2):118-133. doi:10.1158/2643-3230.bcd-22-0074
23 SHI X, YAN L, SHANG J, et al. Anti‐CD19 and anti‐BCMA CAR T cell therapy followed by lenalidomide maintenance after autologous stem‐cell transplantation for high‐risk newly diagnosed multiple myeloma[J]. Am J Hematol, 2022,97(5):537-547. doi:10.1002/ajh.26486
24 ZHOU Z, LIU X, ZHANG X, et al. Effects of Consolidation Therapy With Autologous Hematopoietic Stem Cell Transplantation After BCMA-CAR T-Cell Therapy on the Survival of Patients With Relapsed or Refractory Multiple Myeloma[J].Transplant Cell Ther, 2024,30(11):1080.e1-1080.e11. doi:10.1016/j.jtct.2024.08.024
25 LI C. Phase I Clinical Study of a Fully Human BCMA-targeting CAR (CT103A) Combined With Selinexor in the Treatment of Patients With Relapsed/Refractory Extramedullary Multiple Myeloma: NCT05201118[R]. clinicaltrials.gov, 2022. doi:10.1182/blood-2023-181394
26 MOHAN M. A Multicenter Phase Ⅱ Study of Maintenance Belantamab Mafodotin (Blenrep?) After BCMA-Directed Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed and/or Refractory Multiple Myeloma: NCT05117008[R]. clinicaltrials.gov, 2023.
27 FU B, LIU R, GAO G, et al. Mechanisms and salvage treatments in patients with multiple myeloma relapsed post-BCMA CAR-T cell therapy[J]. Front Immunol, 2024,15:1433774. doi:10.3389/fimmu.2024.1433774
28 LI W, ZHANG B, CAO W, et al. Identification of potential resistance mechanisms and therapeutic targets for the relapse of BCMA CAR-T therapy in relapsed/refractory multiple myeloma through single-cell sequencing[J]. Exp Hematol Oncol, 2023,12(1):44. doi:10.1186/s40164-023-00402-5
29 LEDERGOR G, FAN Z, WU K, et al. CD4+ CAR T-cell exhaustion associated with early relapse of multiple myeloma after BCMA CAR T-cell therapy[J]. Blood Adv, 2024,8(13):3562-3575. doi:10.1182/bloodadvances.2023012416
30 LEE H, AHN S, MAITY R, et al. Mechanisms of antigen escape from BCMA- or GPRC5D-targeted immunotherapies in multiple myeloma[J]. Nat Med, 2023,29(9):2295-2306. doi:10.1038/s41591-023-02491-5
31 SAMUR M K, FULCINITI M, AKTAS SAMUR A, et al. Biallelic loss of BCMA as a resistance mechanism to CAR T cell therapy in a patient with multiple myeloma[J]. Nat Commun,2021,12(1):868. doi:10.1038/s41467-021-21177-5
32 FU B, LIU R, GAO G, et al. Mechanisms and salvage treatments in patients with multiple myeloma relapsed post-BCMA CAR-T cell therapy[J]. Front Immunol, 2024,15:1433774. doi:10.3389/fimmu.2024.1433774
33 VAN OEKELEN O, NATH K, MOUHIEDDINE T H, et al. Interventions and outcomes of patients with multiple myeloma receiving salvage therapy after BCMA-directed CAR T therapy[J]. Blood, 2023,141(7):756-765. doi:10.1182/blood.2022017848
34 CHEN D, WANG X, CHEN Z, et al. Subsequent anti‐myeloma therapy after maturation antigen ( BCMA ) chimeric antigen receptor ( CAR )‐T cell ( HDS269B ) treatment in patients with relapsed/refractory multiple myeloma[J]. Am J Hematol, 2022,97(12):E478-E481. doi:10.1002/ajh.26745
35 CHARI A, MINNEMA M C, BERDEJA J G, et al. Talquetamab, a T-Cell–Redirecting GPRC5D Bispecific Antibody for Multiple Myeloma[J]. N Engl J Med, 2022,387(24):2232-2244. doi:10.1056/nejmoa2204591
36 TRUDEL S, COHEN A D, KRISHNAN A Y, et al. Cevostamab Monotherapy Continues to Show Clinically Meaningful Activity and Manageable Safety in Patients with Heavily Pre-Treated Relapsed/Refractory Multiple Myeloma (RRMM): Updated Results from an Ongoing Phase I Study[J]. Blood, 2021,138 (): 157. doi:10.1182/blood-2021-147983
37 TOUZEAU C, KRISHNAN A Y, MOREAU P, et al. Efficacy and safety of teclistamab (tec), a B-cell maturation antigen (BCMA) x CD3 bispecific antibody, in patients (pts) with relapsed/refractory multiple myeloma (RRMM) after exposure to other BCMA-targeted agents[J]. J Clin Oncol, 2022, 40(): 8013. doi:10.1200/jco.2022.40.16_suppl.8013
38 VAN OEKELEN O, MOUHIEDDINE T H, PAN D, et al. Clinical Outcomes and Treatment Strategies for Relapsed/Refractory Myeloma Patients after Relapse on BCMA-Targeted CAR T[J]. Blood, 2021, 138(): 2704. doi:10.1182/blood-2021-152243
39 CHARI A, VOGL D T, JAGANNATH S, et al. Selinexor‐based regimens for the treatment of myeloma refractory to chimeric antigen receptor T cell therapy[J]. Br J Haematol, 2020,189(4):e126-e130. doi:10.1111/bjh.16550
40 HUANG H. Clinical Trial for the Safety and Efficacy of CS1-targeted CAR-T Cells Therapy for Relapsed Multiple Myeloma After BCMA CAR-T Cells Therapy: NCT04541368[R]. clinicaltrials.gov, 2020. doi:10.31525/ct1-nct04272151
41 CHUNG A. Phase II Study of Pembrolizumab in Multiple Myeloma Patients Relapsing After or Refractory to Anti-BCMA CAR-T Therapies: NCT05191472[R]. clinicaltrials.gov, 2022. doi:10.1182/blood-2022-170744
42 MAILANKODY S, DEVLIN S M, LANDA J, et al. GPRC5D-Targeted CAR T Cells for Myeloma[J]. N Engl J Med, 2022,387(13):1196-1206. doi:10.1056/nejmc2213985
43 XIA J, LI H, YAN Z, et al. Anti-G Protein-Coupled Receptor, Class C Group 5 Member D Chimeric Antigen Receptor T Cells in Patients With Relapsed or Refractory Multiple Myeloma: A Single-Arm, Phase Ⅱ Trial[J]. J Clin Oncol, 2023,41(14):2583-2593. doi:10.1200/jco.22.01824
44 石亚群,俞妍慧. 嵌合抗原受体T细胞治疗致细胞因子释放综合征与神经毒性的现状及展望[J]. 实用医学杂志,2021,37(2):268-271.
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