Cart‐cell therapy: Recent advances and new evidence in multiple myeloma

Abstract

Despite the improvement in survival outcomes, multiple myeloma (MM) remains an incurable disease. Chimeric antigen receptor (CAR) T‐cell therapy targeting B‐cell maturation antigen (BCMA) represents a new strategy for the treatment of relapsed/refractory MM (R/R). In this paper, we describe several recent advances in the field of anti‐BCMA CAR T‐cell therapy and MM. Currently, available data on anti‐BCMA CART‐cell therapy has demonstrated efficacy and man-ageable toxicity in heavily pretreated R/R MM patients. Despite this, the main issues remain to be addressed. First of all, a significant proportion of patients eventually relapse. The potential strategy to prevent relapse includes sequential or combined infusion with CAR T‐cells against targets other than BCMA, CAR T‐cells with novel dual‐targeting vector design, and BCMA expression upregu-lation. Another dark side of CART therapy is safety. Cytokine release syndrome (CRS) andneuro-logic toxicity are well‐described adverse effects. In the MM trials, most CRS events tended to be grade 1 or 2, with fewer patients experiencing grade 3 or higher. Another critical point is the ex-tended timeline of the manufacturing process. Allo‐CARs offers the potential for scalable manufacturing for on‐demand treatment with shorter waiting days. Another issue is undoubtedly going to be access to this therapy. Currently, only a few academic centers can perform these procedures. Recognizing these issues, the excellent response with BCMA‐targeted CAR T‐cell therapy makes it a treatment strategy of great promise.