Autologous BCMA-CART successfully treats refractory relapsed multiple myeloma with TP53 gene mutation and central nervous system infiltration
The patient had a yellow watery stool after 1 year of warming, 1-2 times/d, accompanied by anorexia, no mucus, pus and blood, no abdominal pain, fever, and the number of posterior defecation gradually increased, accompanied by stench. In the capital The Department of Gastroenterology, Beijing Shijitan Hospital, affiliated to the Medical University, showed colonic multiple polyps of about 0.3 cm in diameter and pathologically showed tubular adenoma grade I. Blood routine, routine, and superior bacteria, thyroid function, tumor markers, food allergies The original test was normal.
After the symptomatic support treatment, the stool turned yellow soft stool. After the above symptoms still appear repeatedly, accompanied by dizziness, fatigue, gastroscope showing chronic superficial gastritis with hemorrhage, erosion, gastric retention; full digestive system angiography The oral contrast agent was given to the ascending colon in about 4 hours. No abnormal abnormalities were found in the nuclear magnetic resonance imaging (MRI). Symptomatic supportive therapy was still given. The patient had a short-term syncope after diarrhea in 2 months, no incontinence. In the first half of the month, the number of seizures increased compared with the previous ones. For further diagnosis and treatment, the Department of Gastroenterology, Beijing Shijitan Hospital, affiliated to Capital Medical University. The patient's self-inflicted mentality is poor, and the body weight is reduced. Kg. There was no obvious abnormality in the heart, lung and abdomen. There was a history of hypertension and type 2 diabetes. The antihypertensive and hypoglycemic drugs were stopped for 2 years. 2 years ago, the perianal abscess was treated with perianal abscess.
Before Mr. Chase went to the hospital, they had repeatedly communicated through emails, including his previous history of the disease and related issues related to cell therapy. Mr. Chase, who is 1.8 meters tall and weighs 80 kilograms, seems to be "healthy", but his multiple tumor indicators are high in the examination. The whole body's PET-CT examination has pleura, bones and joints on the limbs. Multiple "bright spots" can be diagnosed as relapsed and refractory multiple myeloma. Because the tumor cells will destroy the bone and cause osteolytic destruction, Mr. Chase has obvious body pain when he comes to the hospital. Sometimes he needs to take a variety of painkillers to help relieve pain.
Mr. US had a serious "cytokine storm"
After admission, the inspection was completed and Mr. Chase began accepting cell collection. After successfully collecting a certain number of cells, Mr. Chase was temporarily discharged.
Humorous Mr. Chase told reporters that since he came to China for the first time, he could not lie on his bed. So he and his wife visited Nanjing, Suzhou and Hangzhou within two weeks of temporary discharge. "China's culture is different from that of the United States. I really like the Zhongshan Mausoleum in Nanjing and the West Lake in Hangzhou. Although Chinese food is not eaten, I am used to it, but I like noodles. The short trip also makes our mood better."
During the two weeks of Mr. Chase's outing, the hospital experts and the cooperating drug companies will collect the good cells and apply the targeted antibodies to the T cells collected by Mr. Chase through special treatment.
On August 11, Mr. Chase was admitted to the hospital again to receive CAR-T cell reinfusion treatment. On the first day after the cell was returned, Professor Li Jianyong came to the ward to investigate the situation, especially to understand Mr. Chase's situation, and communicated with Professor Chen Lijuan and customized the follow-up treatment and the emergency treatment plan in case of side reaction.
In the first week after the return, Mr. Chase's physical condition was basically stable, and when everyone thought that it would be able to pass it smoothly, the disease was attacked again. On August 16th, Mr. Chase experienced high fever and reached 41 degrees of heat for three consecutive days. At noon on Friday, August 18, Chase developed difficulty breathing, decreased pulse oxygen, increased heart rate, and multiple joint pains in the body. Blood tests showed that cytokines were 3000 times normal. "It should be a cytokine storm. In fact, cytokine storm is a kind of help signal from the immune system. The purpose is to let the immune system attack the tumor cells with full firepower, but it will also leave a lot of damage. For example, patients will It is very dangerous to have septic shock or vascular damage, inflammation, fever, and generalized pain."
Mr. Chase, who experienced the game of life and death, lost 10 pounds and looked a little thinner, but did not change his true color. He looked at the medical staff who came to the house every day and smiled and said, "Thank you for coming here to open the party!", "Doctor Chen has a pair of 'magic hand'!" Looking at Professor Chen Lijuan to treat his swollen cockroaches When the joints were specially purchased from the provincial hospital for herbal medicine to help him apply, he would also jokingly say that he "smells like the appetizer of Italian cuisine."
Professor Chen Lijuan told reporters that although Mr. Chase's treatment is over, follow-up follow-up will continue. She will also keep in touch with Mr. Chase's family doctor to observe the treatment effect and follow-up. Although myeloma is still an incurable disease at present, as a medical staff, I sincerely hope that this treatment will give Mr. Chase more opportunities to survive.