Inclusion Criteria:
- Patients must have histologically confirmed MM by MSKCC pathologist.
- Age ≥ 18 years of age
- Diagnosis of relapsed or refractory multiple myeloma with at least 3 prior lines of
therapy.
- Refractory myeloma is defined as disease that progresses while on therapy or within 60
days after the last therapy. Relapsed myeloma id defined as previously treated myeloma
with initial response and subsequent progression (per IMWG criteria) not meeting
criteria for refractory disease.
- At least 3 prior lines of therapy; Prior therapy should include all of the following-
- A proteasome inhibitor (e.g. bortezomib, carfilzomib, ixazomib)
- An immunomodulatory drug (e.g. thalidomide, lenalidomide, pomalidomide)
- A CD38 monoclonal antibody (e.g. daratumumab)
- High dose chemotherapy with autologous stem cell support (ASCT) Subjects who are
not candidates to receive one or more of the above treatments are eligible for
the trial
- ECOG performance status of 0 or 1
- HGB ≥ 8 g/dl, ANC≥ 1,000/mm3, Platelet≥ 50,000/mm3 without red cell transfusion for 21
days, platelet transfusion for 7 days and or growth factor support (Neupogen or
Neulasta) for at least 14 days prior to initial screening (screening A). HGB ≥ 8 g/dl,
ANC≥ 1,000/mm3, Platelet≥ 20,000/mm3 prior to pre-treatment screening (screening B).
Patients are allowed to receive transfusion support prior to the pre-treatment
screening but no growth factor support (Neupogen or Neulasta) for 7 days prior to
pre-treatment screening.
- Measurable disease defined as meeting at least one of the criteria below-
- Serum M protein ≥ 0.5 g/dL
- Involved serum free light chain ≥10 mg/dL with an abnormal free light chain ratio
- Urine M-protein ≥ 200 mg/24 hours
- Measurable plasmacytomas seen on imaging (≥ 1 lesion that has a single diameter ≥
2 cm) If this is the primary marker of measurable disease, patients will need a
biopsy at the pre-treatment screening (screening B).
- Bone marrow plasma cells ≥ 30% as determined by CD138 immunohistochemistry
staining
- Serum creatinine ≤ 1.5mg/dL or a measured creatinine clearance ≥ 50 mL/min (using
24-hour urine collection)
- ALT and AST ≤ 3 X ULN and total bilirubin ≤ 2 mg/dL (or < 3 mg/dL for individuals with
Gilbert's syndrome)
- PT and PTT ≤ 1.5 X ULN
- Adequate pulmonary function as assessed by ≥92% oxygen saturation on room air by pulse
oximetry
- Adequate cardiac function, defined as LVEF ≥ 40% by echocardiogram performed within 4
weeks of initial screening
- For patients with prior ASCT, at least 100 days since ASCT at the time of initial
screening
Exclusion Criteria:
- Pregnant or lactating women. Women and men of childbearing age should use highly
effective contraception while on this study and continue for 1 year after all
treatment is finished.
- Patients with following cardiac conditions will be excluded:
- New York Heart Association (NYHA) stage III or IV congestive heart failure
- Myocardial infarction ≤6 months prior to enrollment
- History of clinically significant ventricular arrhythmia or unexplained syncope,
not believed to be vasovagal in nature or due to dehydration
- History of severe non-ischemic cardiomyopathy
- Patients with HIV or active hepatitis B or hepatitis C infection are ineligible.
- Current diagnosis of primary and secondary plasma cell leukemia is excluded. History
of plasma cell leukemia is not excluded.
- Patients who have not received any myeloma therapy for the preceding 6 months, except
if the last myeloma therapy was a CAR T cell therapy.
- At least 14 day washout from myeloma therapies prior to leukapheresis and prior to
starting lymphodepletion. The washout for experimental treatments would be 5 half
lives or 14 days (whichever is shorter).
- At least 14 day washout from radiation prior to leukapheresis and prior to starting
lymphodepletion.
- Patients treated with previous GPRC5D targeted therapies would be excluded.
- Patients with any concurrent active malignancies (or another primary malignancy not in
remission for at least 2 years) as defined by malignancies requiring any therapy other
than expectant observation or hormonal therapy, with the exception of squamous and
basal cell carcinoma of skin.
- Patients with a prior allogeneic transplant at least 6 months prior to study
enrollment ARE eligible UNLESS experienced GvHD that required systemic steroids or
other systemic lymphotoxic therapy within 12 weeks of initial screening
- Patients on systemic steroids (except if solely for adrenal replacement) within two
weeks of collection
- Active auto-immune disease including connective tissue disease, uveitis, sarcoidosis,
inflammatory bowel disease, or multiple sclerosis, or have a history of severe (as
judged by the principal investigator) autoimmune disease requiring prolonged
immunosuppressive therapy
- Prior or active CNS involvement by myeloma (e.g. leptomeningeal disease). Screening
for this, for example, by lumbar puncture, is only required if suspicious symptoms or
radiographic findings are present.
- Pre-existing (active or severe) neurologic disorders (e.g. pre-existing seizure
disorder)
- Active uncontrolled acute infections
- Any other issue which, in the opinion of the treating physician, would make the
patient ineligible for the study.
