Novel Approaches and the Role of Transplant in Myeloma

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Topics include: Treatments

Dr. Damian Green, a myeloma expert from Seattle Cancer Care Alliance, discusses the role of transplant in myeloma and the continuous refinements to induction therapy. Dr. Green speaks about ongoing studies in myeloma, how pre-targeting radioimmunotherapy might be utilized, and explores the potential to use novel therapies prior to transplant to increase the rate of success.

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With us is a specialist in the Seattle Cancer Care Alliance, Dr. Damian Green, who specializes in the treatment of multiple myeloma.  Thanks for being with us. 

In fact, more patients undergo an autologous stem cell transplant for multiple myeloma in the United States every year than for any other disease, and the numbers continue to grow.  I think that’s a reflection of the continued importance of autologous transplant. 

And there is some data, not a lot of data addressing transplant because of all these other new exciting therapies perhaps as well, and transplant has remained a mainstay, but not much has changed there in terms of how we’re approaching it, but nonetheless there is data here that continues to support the role of autologous transplant.  One thing we don’t yet know is whether an autologous transplant early on after initial induction therapy versus waiting until patient’s disease relapses—and unfortunately in almost all cases, a huge majority of cases, the disease does relapse—waiting till that point, and there’s an ongoing study looking at that. 

We don’t yet have the results from that study, but that’s an IFM/Dana-Farber study, and we’re looking forward to those results.  But for now regardless of what that study shows we continue to believe, and there’s data support, the important role of transplant in patients with this disease if they’re good candidates for the transplant. 

Some folks have said, well now—this is the era of novel therapies, and they are correct.  This is an exciting new era.  There is not data though that demonstrates that the novel therapies abrogate entirely or remove the benefits from an auto transplant as well.  My view is for now that the combination of those two things, using novel therapies in combination with an auto transplant in the right way, is still the best approach for these patients. 

One approach is certainly to integrate novel therapies into conditioning before transplant.  My own research, and I’m presenting an abstract here, an oral session on Tuesday, is looking at a way to use radioimmunotherapy, targeted delivery of small radioactive molecules selectively to the target plasma cells, malignant plasma cells in the bone marrow, and in so doing we would like to then be able to wipe out every last one of those malignant cells. 

The—our view of using that, and we’ve done this already in lymphoma context as well as leukemia, in AML in our center for now many years, we’ve been using high doses of radioimmunotherapy, radioactive particles attached to antibodies, targeting specifically, as specifically as we can, the target sites, and then coming in with a rescue of autologous stem cells.  That allows us to target those malignant cells and marrow even if there might be some off-target effects because other cells—our target is CD38—other cells do express CD38, but we have in the bank those stem cells we can bring back in to repopulate the marrow and rescue the normal CD38-expressing cells.  We’ve done that in lymphoma with CD20.  We’ve done that in leukemia with CD45. 

In New Orleans and for the Seattle Cancer Care Alliance, I’m Andrew Schorr.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on April 27, 2014