05/06/2021 By Christian Bullock (reviewed for medical accuracy by Dr. Dan Platt)
This program was co-hosted by GRYT Health and Multiple Myeloma Research Foundation
On March 24, 2021, GRYT Health partnered with the Multiple Myeloma Research Foundation (MMRF) to host a Multiple Myeloma Meetup.
Below is a video recording of this hour-long program. The following is a summary of the information presented.
Mary DeRome, Director, Medical Communications and Education, joined us to discuss recent treatment news, therapies, and general multiple myeloma information.
Mary started by level-setting on what MM is.
What is Multiple Myeloma?
At a basic level, multiple myeloma is a cancer of the blood. MM grows inside the bones in the bone marrow. Bone marrow is the “blood factory” of the human body. Blood cells are produced inside your bone marrow.
What happens with multiple myeloma is that one of the cell types becomes altered – or mutated – and starts to grow out of control. With multiple myeloma, the type of cell this happens to is a plasma cell, a type of white blood cell that secretes antibodies.
Multiple myeloma is the second most common type of blood cancer for all humans; however, it is the most common type of blood cancer for African Americans.
In 2020, there were 32,270 new cases of MM diagnosed in the United States. The median age for a diagnosis was 69 years old. And myeloma accounts for just below 2% of new cancer cases in the United States.
Common Signs and Symptoms of Multiple Myeloma
One of the first symptoms is low blood counts. This is due to the growth of abnormal plasma cells that “crowd out” other cells. This causes decreased red blood cell counts, know as anemia, which leads to fatigue and weakness. It also causes decreased white blood cell counts, which makes the body less able to resist infections.
In over half of myeloma patients, there is also decreased kidney function. This is due to the excess antibody proteins produced by the cancer cells that essentially “clog” the kidneys and prevent from functioning appropriately.
85% of all myeloma patients have bone damage, which can lead to fractures. This occurs because the plasma cells also secrete proteins that degrade bone.
Symptomatic myeloma is defined by C.R.A.B.:
- Calcium elevation (>11 mg/dL)
- Renal insufficiency: low kidney function (serum creatinine >2 mg/dL)
- Anemia: low red blood count (Hemoglobin <10 g/dL)
- Bone disease (> 1 lytic lesions on skeletal radiography, CT, or PET-CT)
Also important to note: 10-20% of patients with newly diagnosed myeloma do not exhibit any symptoms! In these situations, MM is usually found during a routine physical exam or picked up by blood or urine tests.
Multiple Myeloma Treatment Paths
The current treatment paradigm for newly diagnosed multiple myeloma is the following:
For transplant candidates: Induction therapy -> Stem cell transplant -> consolidation therapy -> maintenance therapy
For non-transplant candidates: Induction therapy -> maintenance therapy
Transplant or non-transplant guidance is done by evaluating the patient’s general health, such as looking at any existing comorbidities, as well as age, organ function, risk assessment, and personal factors
The guiding principles of treating MM:
- A triplet regimen: use three drugs for induction therapy
- Aim for the deepest response
- Consider stem cell transplant either now or later
All of the treatment decisions are made based on the individual patient, and treatment often varies greatly from patient to patient.
Patients almost always relapse with multiple myeloma. When choosing therapy for relapsed/refractory myeloma, the following is taken into account:
- What previous treatment was used
- How well did the treatment work
- Patient factors such as age, comorbidities, side effects of earlier treatments, and more
The following are the main classes of drugs used to treat multiple myeloma in the frontline and relapsed setting:
Multiple Myeloma and Immunotherapy: Exciting Developments
There are various types of immunotherapy drugs now available for multiple myeloma patients. They include:
- Monoclonal antibodies: directly targeting myeloma cell markers
- Immunomodulatory drugs (IMiDs), checkpoint inhibitors: overcoming immune suppression
- CAR T-cells/t-cell antibodies: boosting myeloma-fighting t-cells
- Vaccines: activating myeloma-specific immunity
CAR T-cell therapy is an exciting therapy option for multiple myeloma right now. CAR T-cell therapy has been approved as a treatment for other cancer types. In March 2021, the first CAR T-cell therapy for multiple myeloma was approved by the FDA. How it works:
- T-cells are removed a patient’s blood and genetically modified outside the body.
- Genetically modified T cells are designed to recognize specific proteins on multiple myeloma cells.
- CAR T-cells are returned to the patient and activate once in contact with a MM cell, destroying it.
- CAR T-cells may provide long-lasting benefits, as they may survive in the body for long periods.
- New types of CAR T-cells are being produced to make the process simpler, more efficient, and more effective.
Types of Antibodies for Multiple Myeloma Treatment
Several different types of antibodies can be used to treat MM. Those include:
- “Naked” antibodies: these bind to the surface of myeloma cells and kill them indirectly.
- Antibody-drug conjugate (ADC): An antibody binds to the myeloma cell and the chemotherapeutic drug enters the cell and directly kills it
- Bispecific antibody / bispecific T-cell engager (BiTE): A bispecific antibody looks like a regular antibody, but it has two different “arms.” One binds to the myeloma cell and the other to a T-cell to bring them together so the T-cell can kill the myeloma cell.
Mary talked about a clinical trial called MyDRUG (Myeloma–Developing Regimens using Genomics), which is an example of precision medicine. This type of trial uses DNA sequencing to evaluate the genetic make-up of a patient’s myeloma cells and then tailors treatment to specific mutations present in that individual. This means that each person in the trial will receive different mix of treatments targeted at their own unique mutations.
MMRF’s CureCloud is a bold new initiative which will integrate vast amounts of health data from thousands of multiple myeloma patients in the first at-home genomic testing program. It is the first, largest and most comprehensive database of its kind in myeloma. It is also an invaluable resource to the scientists, doctors and patients working to find treatments, improve patient quality of life and ultimately develop cures. This initiative by MMRF went through a research pilot in 2019 and was officially launched in July 2020.
Where is the multiple myeloma field heading? Exciting treatment possibilities! This includes:
- Staging with genomics and advanced imaging
- Higher efficiency using four-drug regimens
- Precision medicine and targeted therapies in subsets of patients
- MRD-driven therapy
- Minimizing long-term toxicities so MM patients can live longer
- New drug classes and immunotherapies
We want to thank Mary DeRome for bringing her expertise to the GRYT Health community! We are honored to partner with the great team over at MMRF! For more information about multiple myeloma and its treatment, as well as great resources and support, please visit MMRF by clicking here.