Hakan Goker, Engin Kelkitli, Elifcan Karakulak Aladag, Haluk Demiroglu, Mehmet Turgut, Suman Kambhampati, Maxwell Krem
Department of Hematology, Medical Faculty of Hacettepe University, Ankara, Türkiye.
Department of Hematology, Medical Faculty of Ondokuz Mayis University, Samsun, Türkiye.
Front Med (Lausanne). 2024 Aug 28;11:1413825. doi: 10.3389/fmed.2024.1413825. eCollection 2024.
The past decade has seen the development of immunotherapy for the treatment of multiple myeloma (MM), beginning with monoclonal antibodies (mAbs) in the relapsed and refractory setting and culminating in the market approval of chimeric antigen receptor T cells (CAR-T) and bispecific antibodies (BsAbs). The medical community is evaluating the efficacy and safety of these targeted immunotherapies, most of which currently target B-cell maturation antigen (BCMA) on the surface of plasma cells. Two anti-BCMA CAR-T products are available for treating relapsed or refractory MM: idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel). Ide-cel and cilta-cel demonstrate the ability to induce deep responses in heavily pretreated diseases, including patients with triple-class-refractory and penta-refractory diseases. However, there are key similarities and differences regarding these agents, unknowns regarding their comparative efficacy and toxicity, and mechanisms underlying resistance to these new immunotherapies. This review discusses CAR-T cell therapy in relapsed refractory MM, with a focus on efficacy, toxicities, and the evolving trajectories of these therapies in the USA, as well as access in Turkey.
在过去十年中，多发性骨髓瘤（MM）的免疫治疗取得了进展，从复发和难治性病例中使用的单克隆抗体（mAb）开始，最终嵌合抗原受体T细胞（CAR-T）和双特异性抗体（BsAb）获得市场批准。医学界正在评估这些靶向免疫疗法的疗效和安全性，目前大多数疗法靶向浆细胞表面的B细胞成熟抗原（BCMA）。有两种抗BCMA CAR-T产品可用于治疗复发或难治性MM：idecabtagene vicleucel（ide-cel）和ciltacabtagene autoleucel（cilta-cel）。Ide-cel和cilta-cel显示出在经过大量预处理的疾病中诱导深度缓解的能力，包括三重难治和五重难治疾病的患者。然而，这些药物存在关键的异同点，它们的比较疗效和毒性尚不清楚，以及对这些新免疫疗法产生耐药性的潜在机制。本综述讨论了复发难治性MM中的CAR-T细胞疗法，重点关注疗效、毒性、这些疗法在美国的发展轨迹以及在土耳其的可及性。
