Multiple myeloma: New, better treatments are improving outcomes
By Jessica Saenz
Multiple myeloma is a blood cancer that forms in plasma cells, a type of white blood cell that helps your body fight infections. When cancerous plasma cells multiply, they can overcrowd healthy cells within your bone marrow — like weeds crowding out healthy plants — and cause complications.
Treatment for multiple myeloma has included traditional forms of cancer therapy, such as chemotherapy, but in recent years, cancer experts have been exploring and improving treatments that can extend periods of remission and enhance quality of life.
Learn about these promising treatments and what they mean for patients:
There is no cure for multiple myeloma, but better treatments are extending life expectancy.
"Multiple myeloma is an incurable blood cancer that produces a lot of proteins that can cause damage to various organs," says Rahma Warsame, M.D., a Mayo Clinic hematologist.
"When I was in medical school, the treatment for multiple myeloma was pretty much chemotherapy — traditional chemotherapy and bone marrow transplant. Those were the only options for a myeloma patient at that time," says Yi Lin, M.D., Ph.D., a Mayo Clinic hematologist. "Since then, we have new agents that really help extend the amount of time that patients are able to live with multiple myeloma."
With cancer experts at Mayo Clinic and around the world working to better understand multiple myeloma treatment, survival rates are showing progress. "I want all myeloma patients to know that the treatments are improving. The quality of life is improving. I've seen it in my own lifetime the significant improvements in survival," says Dr. Warsame.
Immunotherapy is leading multiple myeloma treatment.
Myeloma cells produce proteins that help them fly under the immune system's radar. Immunotherapy, which uses the body's immune system to fight cancer, works by interfering with cancer cells' ability to produce proteins that allow them to hide from the immune system.
Though relatively new, immunotherapy is one of the most promising treatments for multiple myeloma. "Immunotherapy is the new kid on the block if you will, but it has a huge role in the treatment of multiple myeloma," says Dr. Lin.
Now a standard treatment option for multiple myeloma, immunotherapy comes in various forms that stimulate the immune system in different ways. Monoclonal antibodies, for example, can be delivered through an IV, and can flag cancer cells, block cell growth and attack cancer cells.
Immunomodulatory drugs, which can be taken orally, also stimulate the immune system in different ways and can be given to patients orally. "These are pills you can take by mouth, and they are used along the treatment journey for patients from the time of initial diagnosis to subsequent progression or relapse," says Dr. Lin.
CAR-T cell therapy could change the future of multiple myeloma treatment.
Chimeric antigen receptor-T cell therapy, also known as CAR-T cell therapy, is a promising new type of immunotherapy that was approved by the Food and Drug Administration in 2017. In CAR-T cell therapy, a person's T cells — white blood cells that help fight infections — are collected, genetically modified to recognize and attack myeloma cells, and then reinfused into the patient.
"It's like science fiction," says Dr. Lin. "I explain to patients that it's like 'Robocop.' Your T cells' normal job is to fight infection, like cancer cells. But by the time we find myeloma cells in the body, the myeloma cells have figured out ways to outsmart the T cells. We're trying to genetically modify T cells to be stronger, to recognize cancer cells and fight them better."
While CART-T cell therapy is a fast-moving area of exploration for cancer experts, it's not a widely accessible treatment for now. Because it is a new therapy, it is only available at specialized centers with CAR-T cell therapy expertise.
Cancer experts also are trying to better understand which patients can benefit most from this therapy. To be eligible for CAR-T cell therapy, a person needs to be well enough to wait several weeks while the cells are modified, and weather some of the possible side effects.
But when treatment is successful, it's life-changing. "I have had patients who responded to CAR-T treatment tell me this is the best they have felt. They're now remembering what it's like before they were diagnosed with myeloma," says Dr. Lin.
"Patients get nervous because right now CAR-T is offered in the relapse setting after they've already had at least four lines of treatment," she adds. "Up until then, they were used to coming into a chemotherapy unit. Once we tell them: 'You're good. We'll see you in three months just for testing,' they're like: 'Oh, my gosh. What will I do with my time?' That's a great thing to see. And that's not trivial in terms of the benefit this treatment can offer."
"Everyone should get a second opinion when you have a disease like multiple myeloma, so you're really making the best decision on the most novel therapies," says Dr. Warsame.
"What we always want to strive toward is the treatment that can offer the longest period of remission but balance that with the side effects," says Dr. Lin. "If we don't have a treatment where we can guarantee the myeloma will never come back, we want to make sure the time patients have is time where they can do what they want with their life and the activities that are important to them."
Watch Dr. Lin discuss advances in treating multiple myeloma in this "Mayo Clinic Q&A" podcast video: