The potential role of CAR-T in Multiple Myeloma Treatment. A review

Abstract

Background: Multiple myeloma (MM) is a hematologic malignancy, which causes accumulation of plasma cells in the bone marrow. The symptoms of MM are associated with organ dysfunction and include hypercalcemia, renal failure, anaemia and bone destruction. A relatively new and promising therapeutic option for MM is CAR-T therapy. Aim of the study: The study aimed to outline the role of CAR-T therapy in MM treatment.Material and methods: We conducted a literature review containing 24 articles. We described the role of CAR-T in MM therapy, its therapeutic points, the effectiveness of therapy, and its side effects.Results: CAR-T cells transduced with CAR can recognize specific antigens and kill the cancer cells. For MM these specific antigens are integrin β7, SLAMF7, CD138, BCMA, GPRC5D and FCRL5. Integrin β7 in its active form, can be found in MM cells, whereas in other blood cells, integrin β7 is in the inactive form. The expression of SLAMF7 on MM cells is high and uniform, but its function is not clear: expression of SLAMF7 in MM is suspected to increase the survival and adhesion of MM cells to bone marrow stromal cells. CD138's strong expression on MM cells is contributing to their development and proliferation. BCMA expression was not detected in other human tissues, only in MM cells. GPRC5D is highly expressed in bone marrow samples from MM patients, and minimally expressed in other hematologic malignancies. FCRL5 is a protein marker found specifically on plasma cells in MM, its increased expression promotes B cell proliferation. The AlloCAR-T therapy also seems to be an effective method.CAR-T therapy has also adverse effects including cytokine release syndrome, neurological toxicity, haematological disorders and infusion fever. Conclusions: The effects of CAR-T therapy in MM are really promising and give real benefits to patients. For this reason, it should be further developed and subjected to further research.