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    Robust multiple myeloma treatment program holds promise

    At the Medical College of Wisconsin (MCW), the multiple myeloma program is a robust program that has grown throughout the years.

    Providers see approximately 300 new multiple myeloma patients each year at MCW, and perform approximately 120 to 150 stem cell transplant-based treatments annually for myeloma alone. In 2016, providers saw a total of 928 individual multiple myeloma patients.

    MCW is home to the Center for International Bone and Marrow Transplant Research (CIBMTR) and Bone Marrow Transplant Clinical Trials Network (BMT CTN). Approximately,15 to 20 investigator-initiated and industry-sponsored studies for myeloma are ongoing.

    MCW multiple myeloma experts, Parameswaran Hari, MD, interim chief, professor of medicine, hematology and oncology, and Binod Dhakal, MD, MS, assistant professor of medicine, division of hematology/oncology, talked to Managed Healthcare Executive (MHE) about opportunities for healthcare executives to succeed in this area, as well as challenges and how to overcome them.

    MHE: What opportunities exist for healthcare executives in multiple myeloma?

    Hari: We have a number of research studies (both clinical and translational) looking into understanding the unique disease mechanisms and the treatment approaches. One of these is to identify the novel targets that are expressed solely on the surface of multiple myeloma cells by using mass spectroscopy. This study hopes to find some potential druggable targets for further development. One of the ideas that we are working on currently is to understand the potential role of micro-RNA in perturbation of osteoblast maturation in multiple myeloma bone disease (MMBD). With an improved understanding of molecular networks involved in multiple myeloma bone disease; our study hopes to find a potential predictive biomarker for MMBD and also provide a framework for the clinical development of novel therapeutics.

    Recently there has been interest in developing immunotherapeutic targets in multiple myeloma (MM) that enable a patient’s own immune system to develop effective myeloma specific immune responses. We have a number of studies looking into the immune approaches in MM:

    • The BMTCTN 1302 study explores the role of allogeneic stem cell transplant in patients with high-risk multiple myeloma.

    • The CTN 1401 study uses a more personalized immune treatment by generating a myeloma cell-dendritic cell fusion vaccine after autologous stem cell transplant (ASCT).

    • We just completed our own investigator-initiated trial looking at the role of immune checkpoint inhibitors after transplant to enable myeloma specific immunity.

    • The other study uses the natural killer cells (induced or third party) as an immune cellular approach in heavily treated patients.

    • We are also in the process of developing the first ever-dual CAR-T cell therapy in B cell malignancies including multiple myeloma.

    • Furthermore, in collaboration with investigators from University of Wisconsin, Madison, we are working to develop a potential biomarker for immune therapy in MM.

    Next: What promising developments can we anticipate?



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