Bjørn Simensen----Multiple Myeloma (IgG lambda) ISS-II

Congratulations！A patient from Norway, Bjørn Simensen, with two years of sustained remission.

67-year-old gentleman Bjørn Simensen presented to the hospital in September 2017 with complaints of cough and chest pain. During his workup, he was found to have multiple myeloma (IgG lambda) ISS-II. The patient received 4 cycles of bortezomib, lenalidomide and dexamethasone chemotherapy. Post 4 cycles his M protein was less than 1g/l. The patient was then out lenalidomide maintenance (10mg qdx3 weeks per month m) that he continued for the next 2 years. He remained disease-free till the summer of 2021 when during remission assessment he was found to have raised M protein (5g/l). Lenalidomide was stopped and he was started on carfilzomib and daratumumab chemotherapy from October to December 2021. However, the chemotherapy was not effective and post-chemo BM MRD was positive. 

Mr Bjørn Simensen was first seen at Lu Daopei Hospital on 14 February 2022. His BM MRD showed 0.25 per cent abnormal plasma cells. IEF showed IgG and M protein was 3 g/l. PET-CT Scan showed increased uptake in the testis especially the right one which was also enlarged on examination. A testicular biopsy was carried out which showed malignant plasma cells. The patient was selected for CART cell therapy. Preconditioning was done with fludarabine and cyclophosphamide for 3 days. CAR-T Cells were infused on day 0 (4/3/2222). The dose given was 0.5X10^6 /kg. After infusion, patient had neutropenia fever which was controlled with iv antibiotics. Right testicular swelling gradually reduced to normal size. On day 28 BM examination was negative for plasma cells. The patient was discharged from Lu Daopei with regular follow-up in the hematology centre in his city.