Anti-BCMA CAR T-Cell Therapy bb2121 in Relapsed or Refractory Multiple Myeloma

BACKGROUNDPreclinical studies suggest that bb2121, a chimeric antigen receptor (CAR) T-cell therapy that targets B-cell maturation antigen (BCMA), has potential for the treatment of multiple myeloma. METHODSIn this phase 1 study involving patients with relapsed or refractory multiple myeloma, we administered bb2121 as a single infusion at doses of 50×10 6 , 150×10 6 , 450×10 6 , or 800×10 6 CAR-positive (CAR+) T cells in the dose-escalation phase and 150×10 6 to 450×10 6 CAR+ T cells in the expansion phase.Patients had received at least three previous lines of therapy, including a proteasome inhibitor and an immunomodulatory agent, or were refractory to both drug classes.The primary end point was safety. RESULTSResults for the first 33 consecutive patients who received a bb2121 infusion are reported.The data-cutoff date was 6.2 months after the last infusion date.Hematologic toxic effects were the most common events of grade 3 or higher, including neutropenia (in 85% of the patients), leukopenia (in 58%), anemia (in 45%), and thrombocytopenia (in 45%).A total of 25 patients (76%) had cytokine release syndrome, which was of grade 1 or 2 in 23 patients (70%) and grade 3 in 2 patients (6%).Neurologic toxic effects occurred in 14 patients (42%) and were of grade 1 or 2 in 13 patients (39%).One patient (3%) had a reversible grade 4 neurologic toxic effect.The objective response rate was 85%, including 15 patients (45%) with complete responses.Six of the 15 patients who had a complete response have had a relapse.The median progression-free survival was 11.8 months (95% confidence interval, 6.2 to 17.8).All 16 patients who had a response (partial response or better) and who could be evaluated for minimal residual disease (MRD) had MRD-negative status (≤10 -4 nucleated cells).CAR T-cell expansion was associated with responses, and CAR T cells persisted up to 1 year after the infusion. CONCLUSIONSWe report the initial toxicity profile of a BCMA-directed cellular immunotherapy for patients with relapsed or refractory multiple myeloma.Antitumor activity was documented.