Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY, 10029, USA.
Bristol-Myers Squibb, Princeton, NJ, USA.
J Med Case Rep. 2021 Feb 19;15(1):90. doi: 10.1186/s13256-020-02598-0.
Very little is known about the risk that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection poses to cancer patients, many of whom are immune compromised causing them to be more susceptible to a host of infections. As a precautionary measure, many clinical studies halted enrollment during the initial surge of the global Novel Coronavirus Disease (COVID-19) pandemic. In this case report, we detail the successful treatment of a relapsed and refractory multiple myeloma (MM) patient treated with an anti-B cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell therapy immediately following clinical recovery from COVID-19.
The 57 year old Caucasian male patient had a 4-year history of MM and was considered penta-refractory upon presentation for CAR T cell therapy. He had a history of immunosuppression and received one dose of lymphodepleting chemotherapy (LDC) the day prior to COVID-19 diagnosis; this patient was able to mount a substantial immune response against the SARS-CoV-2 virus, and antiviral antibodies remain detectable 2 months after receiving anti-BCMA CAR T cell therapy. The recent SARS-CoV-2 infection in this patient did not exacerbate CAR T-associated cytokine release syndrome (CRS) and conversely the CAR T cell therapy did not result in COVID-19-related complications. One month after CAR T cell infusion, the patient was assessed to have an unconfirmed partial response per International Myeloma Working Group (IMWG) criteria.
Our case adds important context around treatment choice for MM patients in the era of COVID-19 and whether CAR T therapy can be administered to patients who have recovered from COVID-19. As the COVID-19 global pandemic continues, the decision of whether to proceed with CAR T cell therapy will require extensive discussion weighing the potential risks and benefits of therapy. This case suggests that it is possible to successfully complete anti-BCMA CAR T cell therapy after recovery from COVID-19. CRB-402 study registered 6 September 2017 at clinicaltrials.gov (NCT03274219).
关于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）病毒感染对癌症患者构成的风险，我们知之甚少，其中许多患者免疫功能受损，使他们更容易受到多种感染。作为预防措施，许多临床研究在全球新型冠状病毒病（COVID-19）大流行的最初浪潮中停止了入组。在本病例报告中，我们详细介绍了一名复发性和难治性多发性骨髓瘤（MM）患者在 COVID-19 临床康复后立即接受抗 B 细胞成熟抗原（BCMA）嵌合抗原受体（CAR）T 细胞治疗的成功治疗。
这位 57 岁的白人男性患者患有 MM，病史 4 年，在接受 CAR T 细胞治疗时被认为是五重难治性。他有免疫抑制史，并在 COVID-19 诊断前一天接受了一次淋巴细胞清除化疗（LDC）；该患者能够对 SARS-CoV-2 病毒产生大量免疫反应，并且在接受抗 BCMA CAR T 细胞治疗后 2 个月仍可检测到抗病毒抗体。最近该患者感染 SARS-CoV-2 并未加重 CAR T 相关细胞因子释放综合征（CRS），相反，CAR T 细胞治疗并未导致 COVID-19 相关并发症。CAR T 细胞输注一个月后，根据国际骨髓瘤工作组（IMWG）标准，评估该患者为未确认的部分缓解。
我们的病例为 COVID-19 时代 MM 患者的治疗选择以及 CAR T 治疗是否可以用于 COVID-19 康复患者提供了重要的背景。随着 COVID-19 全球大流行的继续，是否进行 CAR T 细胞治疗的决定需要广泛讨论，权衡治疗的潜在风险和益处。本病例表明，在 COVID-19 康复后，有可能成功完成抗 BCMA CAR T 细胞治疗。CRB-402 研究于 2017 年 9 月 6 日在 clinicaltrials.gov 注册（NCT03274219）。
