B细胞成熟抗原(BCMA)为导向的CAR-T细胞疗法是治疗复发性/难治性多发性骨髓瘤(R/RMM)的破坏性方法;然而,优化是必要的,以最大限度地提高患者的利益。我们报道了一名61岁的原发性难治性MM女性,其表现为膜BCMA高表达和可溶性BCMA(sBCMA)低表达,经历4级细胞因子释放综合征,在接受抗BCMACAR-T(CT103A)治疗后死于重症肺炎。该案例强调了评估BCMA表达范围在接受BCMACAR-T治疗的患者中的有效性和安全性的重要性。对于膜BCMA表达极高和sBCMA表达极低的患者,应考虑γ-分泌酶相关基因突变的存在.还应特别注意此类患者的细胞因子释放综合征的预防和治疗。
B cell maturation antigen (BCMA)-directed CAR-T cell therapy is a disruptive approach for treating relapsed/refractory multiple myeloma (R/R MM); however, optimization is necessary to maximize patient benefit. We report the
case of a 61-year-old woman with primary refractory MM who presented with high expression of membrane BCMA and low expression of soluble BCMA (sBCMA), experienced grade 4 cytokine release syndrome, and died fromsevere pneumonia after receiving anti-BCMA CAR-T (CT103A) therapy. This
case highlights the importance of assessing the expression range of BCMA for its efficacy and safety in patients receiving BCMA CAR-T therapy. For patients who present with extremely high membrane BCMA expression and extremely low sBCMA expression, the presence of γ-secretase-related gene mutations should be considered. Special attention should also be paid to the prevention and treatment of cytokine release syndrome in such patients.