At the onset of September, GoBroad Medical Centre was thrilled to announce a piece of uplifting news — the first patient in Shanghai, China treated with the haematopoietic stem cell transplantation in conjunction with  Zevorcabtagene Autoleucel ( also known as zevor-cel, a commercial BCMA-targeting CAR-T cell therapy product ), for refractory multiple myeloma (MM) has been successfully discharged from GoBroad Shanghai Liquan Hospital!

Ms. Qian, 57 years old, was unfortunately diagnosed with MM and has suffered greatly from the disease. After undergoing a series of dramatic treatments, she finally saw a glimmer of hope. The patient spent a crucial 26 days in the transplantation ward, during which the medical team at GoBroad Shanghai Zhaxin/Liquan Hospital, with their outstanding professional skills and attentive care, ensured the smooth progress of the treatment. Now, after a month of evaluating the treatment's effectiveness, exhilarating news has arrived: the patient's primary disease has reached complete remission (CR), and her physical condition is gradually improving. On the eve of her discharge, the medical team specially organized a brief and warm celebration ceremony for Ms. Qian, congratulating her on her rebirth! The patient and her families also expressed their profound gratitude to the medical team.

Disease Challenge: Highly Aggressive Plasmablastic MM

Ms. Qian's battle against cancer has been marked by both adversity and resilience. In November 2023, she urgently sought medical help due to a lump on her left cheek, which was accompanied by swelling and night sweats. The initial diagnosis struck like lightning—plasmablastic lymphoma. Confronted with this diagnosis, Ms. Qian promptly underwent a comprehensive offensive involving radiotherapy, chemotherapy, and targeted drug therapy. Despite these efforts, her condition persistently advanced and worsened, leading to a continuous decline in her physical health.

In April 2024, Ms. Qian arrived at GoBroad Shanghai Liquan Hospital, fueled by a desire for recovery and a fear of the unknown. Following a comprehensive and precise series of examinations, our hospital diagnosed her with a more complex and rare case of relapsed and refractory multiple myeloma with extramedullary infiltration (IgD-λ type, Durie-Salmon staging system stage IA, International Staging System stage I, Revised International Staging System stage III). The primary disease focus had spread to her lymph nodes and thoracoabdominal peritoneum, and had also invaded the right ischium.

MM is a malignant tumor that originates from plasma cells in the bone marrow, with extramedullary infiltration indicating that the tumor has spread to tissues beyond the bone marrow. Ms. Qian is afflicted with the IgD-λ type of myeloma, a particularly rare form characterized by low incidence, high aggressiveness, and poor prognosis, presenting significant challenges to her treatment journey. The disease has progressed rapidly, with extensive infiltration in the thoracoabdominal cavity and widespread involvement of lymph nodes, soft tissues, and bones throughout the body. This has led to her condition being classified as refractory myeloma, with a pathological type of a highly aggressive plasmablastic myeloma.

Treatment Strategy: The Potent Synergy of Autologous Transplantation and CAR-T Therapy

For relapsed and refractory MM, there is currently no standard therapeutic regimen available. Although the medical team has implemented a new chemotherapy regimen, which has temporarily controlled the disease, a more effective therapeutic regimen is urgently needed for achieving long-term deep remission. In light of this, the medical team promptly communicated with Ms. Qian and her families, and considering the patient's physical condition, they customized an advanced personalized treatment strategy—sequential autologous hematopoietic stem cell transplantation followed by BCMA CAR-T (Zevorcabtagene Autoleucel) cell therapy.

As Ms. Qian’s attending physician, Dr. Li Su, the head of the Hematology Department at GoBroad Shanghai Liquan Hospital, emphasized, “The purpose of autologous hematopoietic stem cell transplantation is to restore the patient’s own immune system, thereby rebuilding a strong defense foundation for the body. Following this, CAR T-cell therapy, which employs modern biotechnology to precisely engineer the patient’s own T cells, enables them to target and destroy tumor cells with missile-like precision. The integration of these two treatments not only has the potential to remodel the patient’s immune defenses but also to achieve thorough elimination of tumor cells, aiming for long-term control of the disease and infusing new vitality and hope into her life.”

Embarking on a New Chapter: From the Depths of Despair to a Reawakening of Hope

 In June 2024, Ms. Qian successfully underwent lymphocyte collection. At the same time, her tumor load was significantly reduced through a carefully tailored chemotherapy regimen. Following a brief period of recuperation at home, Mrs. Qian stepped into the transplantation ward of GoBroad Shanghai Zhaxin Hospital in July, marking the beginning of a new chapter in her treatment journey.

The entire treatment process can be succinctly summarized into three closely interconnected steps: "Pre-transplantation conditioning (high-dose chemotherapy)" is designed to eliminate residual tumor cells within the body, thereby creating favorable conditions for stem cell transplantation; "Autologous hematopoietic stem cell transplantation" involves the infusion of the patient's own healthy stem cells to reconstruct the immune system; "Sequential CAR-T cell therapy" then involves the reinfusion of engineered T cells, targeting tumor cells with precision and potency.

 During her treatment, Ms. Qian faced multiple challenges, including bacteremia, pulmonary infection, and gastrointestinal infection. In the face of these complications, the medical team responded promptly, implementing timely and effective anti-infective treatments, which successfully helped Ms. Qian navigate through these difficulties. As the treatment advanced, her symptoms of infection gradually subsided, and follow-up examinations revealed significant improvements in both the chest CT and intra-abdominal infections.

 It is of particular note that Ms. Qian developed a reaction to cytokine release syndrome (CRS) following the infusion of CAR-T cells, with her temperature momentarily spiking to 41°C, alongside shivering. This represents one of the common immune responses associated with CAR-T cell therapy. Despite the concern it raises, this reaction also indirectly signifies the potent efficacy of CAR-T cell therapy. Thanks to the meticulous care and treatment provided by the medical team, Ms. Qian's temperature gradually stabilized, and the CRS reaction was effectively managed.

As time progresses, CAR-T cell therapy has showcased its remarkable therapeutic effects. On the 11th day following the sequential autologous hematopoietic stem cell transplantation and CAR-T cell therapy, the tumor in front of Ms. Qian's chest had significantly shrunk, with granulocyte recovery and hematopoietic function being restored; by the 14th day after the reinfusion of CAR-T cells, she was successfully discharged from the isolation unit and transferred back to the general ward of Liquan Hospital.

 After 30 days of treatment, there came the exhilarating news: the bone marrow examination revealed no presence of tumor cells, and the hematological tumor markers had turned negative, indicating a state of CR. This not only signifies the rapid improvement in Ms. Qian's physical condition but also marks her regaining hope and brightness in life.

The innovative treatment strategy of sequential autologous hematopoietic stem cell transplantation followed by CAR-T cell therapy is progressively unveiling its significant potential in treating relapsed and refractory multiple myeloma. This therapy offers patients the prospect of achieving deep remission, potentially reaching the objective of a functional cure, thus providing a new hope for extending survival and enhancing the quality of life for patients at ultra-high risk and those with relapsed and refractory diseases.

Ms. Qian's path to rebirth not only demonstrates the profound strength and advanced technology of GoBroad Shanghai Zhaxin/Liquan Hospital in treating refractory multiple myeloma, but also offers hope and confidence to many other patients enduring the agony of this disease. Even when confronted with complex and changing conditions, it remains possible to find a path to overcoming the illness and achieving rebirth, through the application of innovative scientific treatments.