Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S486 CAR T-cell therapy, ORR, CR, -MRD was 84% (CI=69%-93%, I2=4%), 75% (CI=55%-89%, I2=0), and 75% (CI=55%-89%, I2=0), respectively. Conclusion: Anti-BCMA, anti-GPRC5D, allogenic anti-BCMA, and dual-target CAR T-cell were effective in heavily pretreated MM patients. Anti-GPRC5D showed a response in BCMA-pretreated patients. Response rates were similar among anti-BCMA, anti-GPRC5D, allogenic anti-BCMA, and dual-target CAR T-cell therapies. More randomized trials are needed to confirm these results. Keywords: MM, CAR-T cell therapy MM-264 Treatment Options for Bronchiolitis Obliterans After Hematopoietic Stem Cell Transplant: A Systematic Review of Clinical Trials in the Last 10 years Wajeeha Aiman MD1, Muhammad Ashar Ali MD2, Shammas Farooq Bajwa MD3, Mohammad Hamza MD4, Nikhilesh Nanjundaiah MBBS5, Syeda Hafsa Kazmi MD6, Zainab Omar MD7, Hamid Shaaban MD8 1New York Medical College - Saint Michael’s Medical Center, Newark, USA. 2Saint Mary’s and Saint Clare’s Hospital, New York Medical College, Denville, USA. 3Advent Health, Orlando, USA. 4Albany Medical Center Hospital, Albany, USA. 5Odessa National Medical University, Odessa, Ukraine. 6Dr. V.R.K. Women’s Medical College, Hyderabad, India. 7Dubai Medical College for Girls, Dubai, UAE. 8New York Medical College - Saint Michael’s Medical Center, Newark, USA Background: One of the severe manifestations of chronic graft-versus-host-disease (cGVHD) is bronchiolitis obliterans syndrome (BOS), which occurs as progressive airway fibrosis after hematopoietic stem cell transplantation (HSCT). Due to the higher morbidity and mortality, multiple treatment studies are still done without clear standard therapy of care. This systematic review aims to assess the efficacy of different treatment options for BOS. Methods: A literature search was conducted on PubMed and Embase with keywords “Bronchiolitis Obliterans” and “Stem Cell Transplant” from 1/1/2012 to 2/10/2023. 635 articles were screened, and we included 2 randomized clinical trials (RCTs, N=54) and 6 non-randomized clinical trials (nRCTs, N=187). Results: In an RCT by Lam et al. (N=22), the mean FEV1% change was -1.21±13.09 with azithromycin compared to the placebo change of +0.74±10.79. In an nRCT by Brownback et al. (N=13), corticosteroids+azithromycin+montelukast showed an FEV1 decline slope of -5.12 cc/month without and +2.27 cc/month with rituximab. In an RCT (N=32) by Bergeron et al., budesonide/ formoterol showed an absolute FEV1 change of 267.5±69.28 vs 17.5±135.6 (P=0.012) with placebo. In an nRCT by Kim et al. (N=61), budesonide+formoterol+montelukast+N-acetylcysteine showed an FEV1 change of 6.36%±12.72 (P=<0.001) after 3 months of treatment. In an RCT by Zhao et al. (N=30), ruxolitinib showed a predicted change of 11%(P=0.029) in mean FEV1. In an RCT by Matthieu et al. (N=22), pirfenidone showed mean rate of change in FEV1 %slope +0.59%/month(P=0.046). In an nRCT by Williams et al. (N=25), montelukast alone showed a median FEV1 % predicted change of -2 (-5 to-3%) with median FEV1 slope after 2 years Rx +1.32 (P<0.0001). In a study by Williams et al. (N=36), fluticasone+azithromycin+montelukast showed absolute improvement in %predicted FEV1 5-10% in 24% and >10% in 10% of the patients. Conclusion: Budesonide+formoterol significantly improved lung function compared to placebo, but azithromycin did not. In single-arm trials, lung function tests significantly improved in patients with BOS after treatment with rituximab, ruxolitinib, pirfenidone, and montelukast. Randomized phase 3 trials are needed to confirm these results. Keywords: MM, bronchiolitis obliterans, stem cell transplant MM-267 Carfilzomib and Dexamethasone as a Treatment Option in Patients With Relapsed Multiple Myeloma Iliriana Alloqi Tahirbegolli MD, PhD.1,2, Afërdita Ukimeraj MD1, Suzana Krasniqi MD1, Duygu Kaçka MD, PhDc.1, Kaltrina Hoda MD1 1Hematology Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo. 2Heimerer College, Prishtina, Kosovo Context: The development and application of several new drugs, including carfilzomib, a second-generation proteasome inhibitor (PI) that binds irreversibly and specifically to its target—the chymotrypsin-like activity of the 20S proteasome—has significantly improved the treatment of multiple myeloma (MM) in the past two decades. The US Food and Drug Administration (FDA) approved its use in 2012 for relapsed and/or refractory MM as a single agent with or without dexamethasone and in combination with lenalidomide. Objective: To present a case of MM treated with a first-generation IP; however, after two relapses in a very short period, treatment was switched to second-generation IP carfilzomib combined with dexamethasone. Design: A case report. Case Study: In 2019, a 65-year-old woman was diagnosed with immunoglobulin G (IgG) kappa MM, with around 50% plasma cells in the bone marrow puncture. She began treatment with the CyBorD protocol (cyclophosphamide + bortezomib + dexamethasone) for four cycles. The bone marrow puncture revealed no neoplastic infiltration, and the patient was offered an autologous stem cell transplant, which she declined and received two more cycles of CyBorD. The patient was in remission and on lenalidomide 10 mg maintenance medication. Repeated punctures yielded 10%, 9%, and 7-8% plasma cells. After 33 months of lenalidomide maintenance medication, a bone marrow puncture revealed 50% plasma cells, indicating a relapse and VRd (bortezomib + lenalidomide + dexamethasone) treatment was initiated. After 8 cycles, the patient was in remission and started lenalidomide maintenance medication. Three months later, the bone marrow puncture results in 20% plasma cells, and the disease relapses for the second time, prompting therapy with carfilzomib, a second-generation PI, plus dexamethasone. The patient is still receiving treatment and shows no signs of the disease. Conclusion: In the present case, the treatment of MM with carfilzomib and dexamethasone is still in its early stages, and there is insufficient evidence of a persistent response to the therapeutic impact to make a
RkJQdWJsaXNoZXIy MTk3NTQxMg==