Anti-G Protein-Coupled Receptor, Class C Group 5 Member D Chimeric Antigen Receptor T Cells in Patients With Relapsed or Refractory Multiple Myeloma: A Single-Arm, Phase â ¡ Trial.

PURPOSE: G protein-coupled receptor, class C group 5 member D (GPRC5D) is considered to be a promising surface target for multiple myeloma (MM) immunotherapy. Here, we report the efficacy and safety of anti-GPRC5D chimeric antigen receptor (CAR) T cells in patients with relapsed or refractory (R/R) MM. METHODS: This phase Ⅱ, single-arm study enrolled patients (18-70 years) with R/R MM. Lymphodepletion was performed before patients received 2 × 106/kg anti-GPRC5D CAR T cells. The primary end point was the proportion of patients who achieved an overall response. Safety was also evaluated in eligible patients. RESULTS: From September 1, 2021, to March 23, 2022, 33 patients were infused with anti-GPRC5D CAR T cells. At a median follow-up of 5.2 months (range, 3.2-8.9), the overall response rate was 91% (95% CI, 76 to 98; 30 of 33 patients), including 11 (33%) stringent complete responses, 10 (30%) complete responses, four (12%) very good partial responses, and five (15%) partial responses. Partial responses or better were observed in nine (100%) of nine patients with previous anti-B-cell maturation antigen (BCMA) CAR T-cell therapy, including two patients who had received repeated anti-BCMA CAR T-cell infusions with no responses at the last time. Grade 3 or higher hematologic toxicities were neutropenia (33 [100%]), anemia (17 [52%]), and thrombocytopenia (15 [45%]). Cytokine release syndrome occurred in 25 (76%) of 33 patients (all were grade 1 or 2), and neurotoxicities in three patients (one grade 2 and one grade 3 ICANSs and one grade 3 headache). CONCLUSION: Anti-GPRC5D CAR T-cell therapy showed an encouraging clinical efficacy and manageable safety profile in patients with R/R MM. For patients with MM that progressed after anti-BCMA CAR T-cell therapy or that is refractory to anti-BCMA CAR T cell, anti-GPRC5D CAR T-cell therapy might be a potential alternative option.

Risk Factors Associated with Durable Progression-Free Survival in Patients with Relapsed or Refractory Multiple Myeloma Treated with Anti-BCMA CAR T-cell Therapy.

PURPOSE: B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T-cell therapy results in high remission rates in patients with relapsed/refractory (R/R) multiple myeloma. However, the factors associated with prognosis following CAR T-cell therapy are unknown. PATIENTS AND METHODS: Between July 1, 2018 and July 31, 2020, 61 patients with R/R multiple myeloma received anti-BCMA CAR T-cell therapy (Chictr.org number, ChiCTR1800017404). Step-wise multivariate Cox regression and competing risk analyses were conducted to identify poor prognosis-associated risk factors. RESULTS: Sixty patients (98.4%) experienced cytokine release syndrome (CRS), including 33, 23, and 4 cases of CRS grades 1 to 2, 3, and 4, respectively. The objective response rate (ORR) was 98.3%, and the complete remission (CR) rate was 70.3%. With a median follow-up period of 21.1 months, the 1-year overall survival (OS) and progression-free survival (PFS) rates were 78.0% and 50.2%, respectively. The median PFS was 12.7 months. Cox modeling revealed that poor PFS was associated with extramedullary disease [HR = 2.59, 95% confidence interval (95% CI) = 1.29-5.21, P = 0.008], light chain multiple myeloma (HR = 2.53, 95% CI = 1.03-5.97, P = 0.035), high-risk cytogenetics (HR = 2.80, 95% CI = 1.27-6.14, P = 0.01), and prior treatment with more than 3 therapeutic lines (HR = 3.14, 95% CI = 1.34-7.34, P = 0.008). Among the 41 CR cases, competing risk analyses demonstrated higher relapse predispositions in those with extramedullary disease (HR = 4.51, 95% CI = 1.86-10.9, P = 0.001), light chain multiple myeloma (HR = 4.89, 95% CI = 1.52 - 15.7, P = 0.008), or high-risk cytogenetics (HR = 5.09, 95% CI = 1.63-15.9, P = 0.005). CONCLUSIONS: Anti-BCMA CAR T-cell therapy is safe and effective for R/R multiple myeloma. For patients with high-risk factors, improvements to extend remission and more specific individualized therapies are needed.

Electrophoresis of two spheres: Influence of double layer and van der Waals interactions.

Considering recent applications of electrophoresis conduced in nanoscaled devices, where particle-particle interaction can play a role, we studied for the first time the electrophoresis of two rigid spheres along their center line, taking account of the hydrodynamic, electric, and van der Waals interactions between them. Under the conditions of constant surface potential and surface charge density, the influences of the level of surface potential/charge density, the bulk salt concentration, and the particle-particle distance on their electrokinetic behaviors are examined. Numerical simulation reveals that these behaviors are much more complicated and interesting than those of isolated particles. In particular, we show that care must be taken in choosing an appropriate particle concentration in relevant experiment to avoid obtaining unreliable mobility data.

Gel electrophoresis of a charge-regulated, bi-functional particle.

Adopting a Brinkman fluid model, we analyzed the electrophoresis of a charged-regulated, bi-functional particle containing both acidic and basic functional groups in a gel solution. Both the long-range hydrodynamic effect arising from the liquid drag and the short-range steric effect from particle-polymer interaction are considered. The type of particle considered is capable of simulating both biocolloids such as microorganisms and cells, and particles with adsorbed polyelectrolyte or membrane layer. Our model describes successfully the experimental data in the literature. The presence of gel has the effect of reducing the particle mobility and alleviating double-layer polarization so that the particle behavior is less complicated than that in the case where gel is absent. On the other hand, both the quantitative and qualitative behaviors of a particle depend highly on solution pH and background salt concentration, yielding interesting and significant results. These results provide valuable information for both experimental data interpretation and electrophoresis devices design.

Analytical expressions for pH-regulated electroosmotic flow in microchannels.

We derived analytical expressions for the pH-regulated electroosmotic flow in a microchannel for arbitrary level of surface potential and type of electrolyte solution; previous results are almost always based on the conditions of low, constant surface potential, which are inaccurate and unrealistic. In addition, an analytical expression for the dependence of the surface potential on the electrolyte concentration and solution pH is obtained, which is capable of explaining the behavior of the empirical relation used in the literature. The analytical results derived are readily applicable to further electrokinetic analyses, and to interpret experimental observations and/or design devices involving electroosmosis such as biosensors and lab-on-a-chip.

Electrical potentials of two identical particles with fixed surface charge density in a salt-free medium.

The electrical potentials of two identical planar, cylindrical, and spherical particles immersed in a salt-free dispersion are solved analytically by a perturbation approach for the case of constant surface charge density. The system under consideration simulates, for example, micelles, where the ionic species in the liquid phase come mainly from the dissociation of the functional groups on the droplet surface. We show that for planar particles, the present zero-order perturbation solution is exact, and for cylindrical and spherical particles, the first-order perturbation solution provides sufficiently accurate results, with an averaged percentage deviation on the order of 1% under typical conditions. In general, the higher the surface charge density, the higher the valence of counterions, the smaller the separation distance between two particles, and the smaller the curvature of particle surface, the better the performance of the perturbation solution.

Electrical potentials of two identical planar, cylindrical, and spherical colloidal particles in a salt-free medium.

A perturbation solution based on the curvature of the surface of a particle is derived for the electrical potential of two planar, cylindrical, and spherical colloidal particles immersed in a salt-free medium. Compared with the available results in the literature, the present approach improves both the accuracy and the applicable range in the level of the surface potential, the valence of counterions, and the thickness of the double-layer surrounding a particle. The zero-order perturbation solution is exact for the case of two planar particles. Under typical conditions, the averaged percentage deviation of the first-order perturbation solution is on the order of ca. 5% for both two cylindrical and two spherical particles.