Redefining light‑chain smoldering multiple myeloma: prevalence and progression risk
Robust CD4(+) CAR T cell expansion is associated with non‑ICANS neurotoxicities after ciltacabtagene autoleucel in patients with multiple myeloma
In a cohort of 109 patients with relapsed/refractory multiple myeloma treated with the CAR‑T cell therapy ciltacabtagene autoleucel, we identified risk factors for non‑immune effector cell‑associated neurotoxicity syndrome (NINT). A high peak absolute lymphocyte count—a surrogate for CAR‑T cell expansion—was found to predict NINT. The expansion was dominated by CD4+ CAR‑T cells with a memory phenotype. These CD4+ CAR‑T cells exhibited increased inflammatory pathway gene expression, suggesting they may be therapeutic targets for mitigating NINT.
The study establishes a refined diagnostic definition for light‑chain SM‑MM and quantifies its annual progression risk (~6 %). This improves early identification and surveillance of patients at risk of progression to symptomatic multiple myeloma or amyloid light‑chain amyloidosis.
Evidence level: Állatkísérletes. Állatmodellben vizsgálták.
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