Abstract: TH-PO0170
B Cell Maturation Antigen (BCMA) Chimeric Antigen Receptor T Cell (CAR-T) Therapy in a Kidney Transplant Recipient (KTR) with Refractory Multiple Myeloma (RMM)
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Oh, Jaha, Weill Cornell Medicine, New York, New York, United States
- Latcha, Sheron, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Relapsed/refractory post-transplant lymphoproliferative disorder (PTLD) develops in 20-30% of KTR following standard treatment for lymphoma with a median overall survival of 4.1 months. BCMA CAR-T cell therapy shows promise for treating RMM and KTR could potentially benefit from BCMA CAR-T cell therapy. A specific challenge for KTR receiving BCMA CAR-Ts is to manage immunosuppressive (IS) medications to optimize an adequate T cell collection against avoiding acute rejection (AR).
Case Description
This is a 79-year-old female with hypertension, chronic kidney disease, pre-emptive living-related renal transplant in 2010 and triclonal multiple myeloma (MM) in 2021. Because the MM was refractory to multiple standard regimens, CAR-T cell therapy was pursued. To optimize T cell yield and function, tacrolimus and mycophenolate mofetil (MMF) were discontinued approximately 10 and 11 weeks prior to infusion, respectively (Figure 1). Prednisone was increased from 5 mg to 10 mg before CAR-T, then reduced back to 5 mg two weeks after infusion. She developed grade 2 cytokine release syndrome on days 8 which responded to tocilizumab. AlloSure levels were 0.67% at 2 weeks and decreased to 0.22% at 10 weeks post-infusion. ImmuKnow assay declined from 563 ng/mL pre-infusion to 319 ng/mL at 2 weeks post-infusion. Based on these findings, MMF was cautiously reintroduced at a half reduced dose three months post-infusion. Currently 15 months post CAR-T cell, the creatinine remains at her baseline (0.8 mg/dL) and she remains in complete remission on serial bone marrow biopsy and PET-CT.
Discussion
KTR with high risk RMM has achieved complete remission following BCMA CAR T cell with, stable renal allograft function with careful management of her IS. Knowledge gaps for future research include how to optimize T cell yield and function in solid organ transplant recipients of CAR T cell therapy and how to optimize their IS medications during the pre and post CAR T infusion period.