BCMA 靶向 CAR-T 细胞治疗后如何选择最佳挽救治疗？

B-cell maturation antigen (BCMA) directed chimeric antigen receptor T-cell therapy (CAR-T) has transformed the treatment of relapsed/refractory multiple myeloma (RRMM), yet relapse is still common for most patients. A variety of different salvage treatment strategies have been studied in the last several years to address several resistance mechanisms that lead to relapse after BCMA CAR-T. To date, there are no clear guidelines regarding treatment sequencing strategies for salvage therapy. This review will investigate the current landscape of available salvage therapies and data supporting their use, as well as possible treatment sequencing strategies to maximize clinical outcomes in this difficult-to-treat population. CAR T-cell therapy is a newer treatment that helps many patients with a blood cancer called multiple myeloma. Many patients get better at first, but the cancer often comes back. There is no single best treatment when this happens. This article reviews the choices when multiple myeloma returns after CAR T-cell therapy against a cancer target called BCMA.

The cancer may come back because the CAR T-cells get weaker, the cancer cells change so they are harder to find, or because of changes in the environment where the blood cells are made. Knowing why can help doctors choose the next treatment. New treatments include medicines that attack different targets on the cancer cells, such as GPRC5D. Some patients may get another BCMA therapy if enough time has passed since the initial CAR-T.

Other choices include standard cancer drugs (chemotherapy), replacing bone marrow with healthy cells (stem cell transplant), or combination therapies that help the immune system fight cancer. Because there are many options, doctors choose treatment based on each patient s health, past treatments, and when the cancer comes back. Multiple myeloma that comes back rapidly or aggressively may limit treatment options. Research studies (clinical trials) are testing the best order for these treatments and how to help patients live longer.