CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题：Combined Immune Checkpoint Inhibitors and Radiation Therapy in Patients with Multiple Myeloma and Extramedullary Medullary Disease: A Real-World Retrospective Analysis.
Combined Immune Checkpoint Inhibitors and Radiation Therapy in Patients with Multiple Myeloma and Extramedullary Medullary Disease: A Real-World Retrospective Analysis.
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我们开展回顾性研究，评估2016年1月至2025年5月期间在Hackensack大学医学中心和John Theurer癌症中心接受免疫检查点抑制剂（ICI）联合放射治疗（RT）的EMD患者的疗效和安全性。纳入标准为确诊EMD并接受纳武利尤单抗或帕博利珠单抗联合RT。
共纳入21例患者，属于高危队列，既往治疗中位线数为6线（范围2–13），其中47.6%为三类药物难治，19.0%为五类药物难治。客观缓解率（ORR）为47.6%，临床获益率为57.1%。尽管观察到应答，中位无进展生存期（PFS）和总生存期（OS）分别为4个月和12个月。值得注意的是，2例患者在细胞治疗后治疗早期接受纳武利尤单抗联合RT，达到完全缓解，且截至末次随访仍无疾病。ICI与RT联合治疗总体耐受性良好，免疫相关不良事件可控制，未发生治疗相关死亡。
这些发现提示，对于部分晚期EMD患者，同步使用ICI和RT可能产生治疗应答信号，但应答持续时间有限。仍需进一步开展前瞻性研究，明确该联合方案的作用并识别最可能获益的患者。
Background/Objectives: Extramedullary disease (EMD) is an aggressive and treatment-resistant manifestation of multiple myeloma with limited therapeutic options, particularly in heavily pretreated patients. Methods: We conducted a retrospective study to evaluate the efficacy and safety of concurrent immune checkpoint inhibitors (ICIs) and radiation therapy (RT) in patients with EMD treated at Hackensack University Medical Center and John Theurer Cancer Center between January 2016 and May 2025.
Patients were included if they had confirmed EMD and received nivolumab or pembrolizumab with concurrent RT. Results: A total of 21 patients were included, representing a high-risk cohort with a median of 6 prior lines of therapy (range 2-13), including 47. 6% triple-class refractory and 19. 0% penta-refractory disease. The overall response rate (ORR) was 47. 6%, with a clinical benefit rate of 57. 1%. Despite these responses, median progression-free survival (PFS) and overall survival (OS) were 4 and 12 months, respectively.
Notably, two patients achieved complete responses with nivolumab and RT early in their treatment course following cellular therapy and remain disease-free at last follow-up. The combination of ICIs and RT was generally well-tolerated, with manageable immune-related adverse events and no treatment-related deaths. Conclusions: These findings suggest that concurrent ICI and RT may provide a signal of treatment responses in a subset of patients with advanced EMD, although durability remains limited.
Further prospective studies are warranted to further define the role of this combination and identify patients most likely to benefit.
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