Multiple Myeloma with Extramedullary Plasmacytoma

This is the case of a 73-year-old male patient diagnosed with multiple myeloma, complicated by the presence of extramedullary plasmacytoma. Throughout the course of treatment with Dara-VRD (Daratumumab, Bortezomib, Lenalidomide, Dexamethasone), the extramedullary plasmacytoma persisted, causing significant pain and discomfort to the patient.

Considering the aggressive nature of the disease and the lack of response to conventional therapies, the patient was enrolled in a clinical trial for BCMA CAR-T cell therapy. After undergoing the necessary preparatory steps, including lymphodepletion, the patient received the infusion of BCMA CAR-T cells.

Remarkably, within 10 days after the infusion, the patient experienced a second-degree cytokine release syndrome (CRS) response, indicating a robust immune activation. Additionally, there was significant localized CRS at the site of the extramedullary plasmacytoma.

What is even more astonishing is that within this short period, the previously treatment-resistant extramedullary lesion, which had proven resistant to multiple lines of chemotherapy, targeted agents, and monoclonal antibodies, completely disappeared. The patient achieved complete remission, marking the success of the treatment.

Throughout the treatment process, the medical team closely monitored the patient for any signs of adverse reactions and provided comprehensive supportive care. This included managing the CRS symptoms and addressing any other treatment-related complications.

As the treatment progressed, the medical team continued to closely monitor the patient's response to BCMA CAR-T cell therapy. Regular assessments were conducted to evaluate the efficacy of the treatment and to address any emerging side effects promptly.

Following the remarkable achievement of complete remission, the patient's quality of life significantly improved, with the relief of pain and discomfort associated with the extramedullary plasmacytoma. With the disease under control, the patient was able to resume daily activities and enjoy a better overall well-being.

Moreover, recognizing the importance of long-term follow-up care, our medical team remained actively involved in the patient's post-treatment journey. Regular follow-up appointments were scheduled to monitor the patient's condition, assess treatment response durability, and address any potential relapse or late-onset side effects.

In addition to medical follow-up, our institution provided comprehensive supportive services to assist the patient in adjusting to life after treatment. This included access to counseling services, rehabilitation programs, and educational resources to help the patient and their family navigate survivorship and maintain a healthy lifestyle.

The successful outcome of this case not only demonstrates the efficacy of BCMA CAR-T cell therapy in treating refractory multiple myeloma but also highlights the importance of personalized and multidisciplinary care in managing complex hematologic malignancies. Our commitment to providing continuous support and follow-up care reflects our dedication to ensuring the best possible outcomes for our patients beyond the treatment phase.

Before & 3 months after infusion