Dados do Resumo

Título

CAR-T Therapy in Multiple Myeloma: A Revolution in Immunotherapy with Current Challenges and Transformative Potential.

Introdução

Chimeric antigen receptor T-cell (CAR-T) immunotherapy represents a promising approach in the treatment of multiple myeloma (MM), a type of hematologic cancer. In this context, CAR-T cells have a potent cytotoxic capacity against multiple myeloma. The main challenges include improving the duration of the response and understanding the mechanisms of resistance.

Objetivo

The study aims to investigate in detail the influence of CAR-T therapy in the treatment of Multiple Myeloma (MM), its transformative potential within the therapeutics proposed for the treatment of the pathology and current challenges.

Métodos

This is a literature review to evaluate the efficacy and current challenges of CAR-T therapy in the treatment of multiple myeloma. The search was conducted in scientific databases, including observational studies, systematic reviews and meta-analyses, as well as PubMed, Scopus and Web of Science, using the descriptors “CAR-T cells” AND BCMA AND “Multiple Myeloma”. 817 results were identified, of which 4 were considered relevant to the research and included in the analysis. The inclusion criteria involved systematic reviews, meta-analyses and phase I, II and III clinical trials from the last 5 years, which evaluated the efficacy of CAR-T therapies targeting BCMA (B-cell maturation antigen) in patients with multiple myeloma. In addition, exclusion criteria were considered, such as studies with insufficient data or lacking methodological rigor. The data was analyzed in order to identify patterns, adverse effects and myeloma recurrence rates.

Resultados

CAR-T therapy targeting BCMA has shown promise for the treatment of multiple myeloma (MM), including cases with central nervous system (CNS) involvement. Studies have shown that patients treated with IDE-cel or CILTA-cel had an overall response rate (ORR) of 73%, with 45% achieving complete response (CR) or stringent complete response (sCR), and 18% achieving very good partial response (VGPR). In the meta-analysis, 100% of patients showed a response in the CNS by day 90, with improvements in imaging tests. Despite this progress, CNS patients are often excluded from clinical trials. Regarding safety, no cases of grade 3 or higher cytokine release syndrome (CRS) were reported, but cases of grade 1/2 CRS and grade 1 neurotoxicity were observed. CNS recurrence was documented in one patient by day 172, while 45% maintained a systemic response at the last evaluation.

Conclusões

CAR-T therapy is a promising technique in the treatment of Multiple Myeloma, especially when there is CNS involvement. However, further studies with longer follow-up are essential to better assess efficacy, safety and long-term tumor recurrence rates. In this sense, additional research is also extremely important to improve patient selection, optimize manufacturing processes and address access and cost challenges.

Palavras Chave

CAR-T therapy; Central nervous system; hematologic cancer