The management of multiple myeloma patients accompanied with disseminated intravascular coagulation before receiving LCAR-B38M therapy

Anti–B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR T)-cell therapy has achieved remarkable success in the treatment of multiple myeloma (MM). Although coagulation disorders and disseminated intravascular coagulation (DIC) have been reported frequently during CAR T-cell therapy, little research has been conducted that focuses on MM patients diagnosed with DIC before CAR T-cell infusion. In this study, we reported on two patients with MM and one patient with primary plasma cell leukemia, all of whom were diagnosed with DIC before infusion with LCAR-B38M, and discussed the management and relationship between cytokine release syndrome (CRS) and DIC. After infusion of CAR T cells, all three patients experienced CRS and aggravated DIC, with CRS tending to precede the deterioration of DIC. Following timely and comprehensive treatment, which included anticoagulant therapy, replacement therapy, treatment for CRS and supportive treatment, all patients were restored to a normal coagulation profile, with two patients achieving complete response and one stable disease. Our study shows that LCAR-B38M can be administered to patients with MM and coagulopathy or DIC and managed appropriately.