Equecabtagene autoleucel as sequential therapy in a multiple myeloma patient with renal failure: a case report

This report describes the efficacy and safety of equecabtagene autoleucel (eque-cel) as sequential therapy in a multiple myeloma (MM) patient complicated with renal failure. The patient was a 50-year-old male diagnosed with MM (IgD-λ subtype, Durie-Salmon stage IIIB, ISS stage III, R-ISS stage II, 1q21+) with severe renal insufficiency. After 4 cycles of daratumumab, bortezomib, and dexamethasone (DVD)/daratumumab, bortezomib, pomalidomide, and dexamethasone (DVPD) induction therapy, the patient achieved hematologic complete remission (CR) and underwent autologous hematopoietic stem cell transplantation (ASCT) for consolidation. During subsequent daratumumab, ixazomib, pomalidomide, and dexamethasone (DIPD) maintenance therapy, intolerance due to recurrent infections and myelosuppression prompted a switch to eque-cel sequential therapy. During treatment, grade I cytokine release syndrome (CRS) was observed, with no severe immune effector cell-related toxicities such as immune effector cell-associated neurotoxicity syndrome (ICANS), infection, or hemophagocytic syndrome; however, hematologic toxicities including grade 3 thrombocytopenia, grade 2 neutropenia, and grade 1 anemia occurred. Efficacy evaluation at day 28 post-Chimeric antigen receptor T(CAR-T) infusion demonstrated CR with minimal residual disease (MRD) negativity. At 21 months of follow-up, the patient has not received any additional MM maintenance therapy and continues to maintain CR with MRD negativity. This case suggests that renal failure is not an absolute contraindication for CAR-T cell therapy, and that CAR-T cell therapy may serve as an alternative to novel agent therapy in selected patients who are intolerant to long-term drug treatment, yielding favorable outcomes, although further validation in more cases and prospective studies is still required.