Despite major advances in targeted therapies and autologous stem cell transplantation (ASCT), multiple myeloma (MM) remains an incurable disease, with most patients ultimately experiencing relapse. BCMA-targeted CAR-T therapy has emerged as a new and powerful treatment option for patients with relapsed or refractory multiple myeloma (RRMM). Eque-cel (Fucaso), a fully human BCMA-directed CAR-T cell therapy, was approved in China in 2023 for patients with RRMM who have received three or more prior lines of therapy, based on the pivotal FUMANBA-1 study.
This case describes a 52-year-old male patient with λ light-chain MM who experienced multiple relapses over more than six years of treatment. From 2018 to 2024, the patient received several lines of proteasome inhibitor– and IMiD-based therapies, including Vd-, PAd-, IRd-, ITd-, and daratumumab-containing regimens. Although partial responses were achieved at different stages, the disease repeatedly progressed, with rising serum and urinary λ light-chain levels and increasing bone marrow plasma cell burden. The patient underwent two autologous stem cell transplants in 2022, achieving temporary disease control, but subsequently relapsed again with aggressive features, including extramedullary involvement.
Given the refractory nature of the disease after extensive prior therapy, the patient proceeded to BCMA CAR-T therapy. Lymphocyte collection was performed in September 2024, followed by bridging therapy and lymphodepleting chemotherapy. Eque-cel infusion was administered on December 20, 2024. Post-infusion, the patient experienced grade 1 cytokine release syndrome (CRS) without immune effector cell–associated neurotoxicity syndrome (ICANS). Symptoms resolved with dexamethasone, and the patient was discharged uneventfully.
At the 3-month efficacy assessment, the patient achieved complete response (CR) with minimal residual disease (MRD) negativity. At follow-up in November 2025, the patient remained in CR, indicating durable disease control more than one year after CAR-T infusion, with good overall tolerability.
Expert Commentary
Prof. Xu Bing
Multiple myeloma is a malignant plasma cell disorder that remains incurable. Although ASCT is recommended for eligible patients, relapse after transplantation is common, and prognosis worsens with each subsequent line of therapy. For patients with multi-line relapsed or refractory MM, effective treatment options are limited, underscoring the need for innovative therapies.
Eque-cel is the first fully human BCMA-targeted CAR-T therapy approved for RRMM based on the FUMANBA-1 study. At the 2025 International Myeloma Society Annual Meeting, 36-month follow-up data showed an overall response rate of 96.3% and a ≥CR rate of 83.2%. In patients without prior BCMA CAR-T exposure, the MRD negativity rate reached 98.9%, with a median progression-free survival of 35.9 months.
Eque-cel uses a lentiviral vector and a fully human CAR structure, resulting in low immunogenicity, rapid in vivo expansion, and long-term persistence. Its optimized antigen-binding design helps balance potent anti-myeloma activity with reduced T-cell exhaustion, supporting durable responses. In this heavily pretreated patient who relapsed after two ASCTs, Eque-cel induced sustained complete remission with good safety, highlighting its potential as an important treatment option for RRMM.
