A recent article suggested a beneficial trial of cell therapy for leukemia:
http://www.sciencedaily.com/releases/2014/02/140219142556.htm
"The largest clinical study ever conducted to date of patients with advanced leukemia found that 88 percent achieved complete remissions after being treated with genetically modified versions of their own immune cells. "These extraordinary results demonstrate that cell therapy is a powerful treatment for patients who have exhausted all conventional therapies," said a senior author. "Our initial findings have held up in a larger cohort of patients, and we are already looking at new clinical studies to advance this novel therapeutic approach in fighting cancer."
Are there a such cell therapy for available for multiple myeloma? Anything in the works worthy of note?
Forums
Re: Cell therapy for leukemia, how about multiple myeloma?
Hi Inq,
The particular therapy discussed in the article is an anti CD19 CAR t cell. Take note Dr. Durie mentions that 2 myeloma patients that did this particular type of therapy had severe heart problems. Dr. Durie discusses this at about 57 minutes into the presentation.
http://www.youtube.com/watch?v=1QosYJBjrVc
The study you are referring to was done at Beacon sponsor Memorial Sloan Kettering. They are one of the leaders in this type of therapy. Unfortunately in a recent peer reviewed piece that I saw an abstract on PubMed, the doctors involved wrote this about myeloma.
" Lastly, we discuss the pre-clinical development and potential for clinical translation for using CAR T cells against multiple myeloma and acute myeloid leukemia. We highlight the potential risks and benefits by targeting these poor outcome hematologic malignancies."
http://link.springer.com/article/10.1007%2Fs12185-013-1479-5
I did not have access to the full paper but it did not sound like myeloma would be at "the top of the list" after reading this abstract. Hopefully I am wrong about that but I have read quite of what the doctors at MSKCC have written about this and I do not recall them discussing myeloma as a disease they are planning on testing this out on in the near future.
The other well known group that is using CAR T cells is at UPENN. Dr. Edward Stadtmauer works there and discusses this as part of his presentation starting at about 44 minutes. Note at different times he describes this as "science fiction" and says that it is only going to be used on patients that have used up all other options. He does discuss some other immunotherapies but unfortunately they have not shown nearly as dramatic of results as the anti CD19 CAR T cells have for CLL and ALL.
http://www.youtube.com/watch?v=jlPf8yndZp8&list=PLAWij8qSJy6QWFk2_tXCM26JvG6RUJ23u
As our experience with the one successful form of immunotherapy that is currently used for blood cancer patients, allogeneic transplant, progress tends to be slow in immunotherapy. It took decades to make allo transplant part of upfront therapy for multiple blood cancers. Dr. Stadtmauer did an excellent job of explaining that these therapies are likely a long ways away from being part of front line/early therapy for myeloma patients. Long term toxicities are unknown since there are no long term survivors of anti CD19 CAR t cell therapy.
Mark
The particular therapy discussed in the article is an anti CD19 CAR t cell. Take note Dr. Durie mentions that 2 myeloma patients that did this particular type of therapy had severe heart problems. Dr. Durie discusses this at about 57 minutes into the presentation.
http://www.youtube.com/watch?v=1QosYJBjrVc
The study you are referring to was done at Beacon sponsor Memorial Sloan Kettering. They are one of the leaders in this type of therapy. Unfortunately in a recent peer reviewed piece that I saw an abstract on PubMed, the doctors involved wrote this about myeloma.
" Lastly, we discuss the pre-clinical development and potential for clinical translation for using CAR T cells against multiple myeloma and acute myeloid leukemia. We highlight the potential risks and benefits by targeting these poor outcome hematologic malignancies."
http://link.springer.com/article/10.1007%2Fs12185-013-1479-5
I did not have access to the full paper but it did not sound like myeloma would be at "the top of the list" after reading this abstract. Hopefully I am wrong about that but I have read quite of what the doctors at MSKCC have written about this and I do not recall them discussing myeloma as a disease they are planning on testing this out on in the near future.
The other well known group that is using CAR T cells is at UPENN. Dr. Edward Stadtmauer works there and discusses this as part of his presentation starting at about 44 minutes. Note at different times he describes this as "science fiction" and says that it is only going to be used on patients that have used up all other options. He does discuss some other immunotherapies but unfortunately they have not shown nearly as dramatic of results as the anti CD19 CAR T cells have for CLL and ALL.
http://www.youtube.com/watch?v=jlPf8yndZp8&list=PLAWij8qSJy6QWFk2_tXCM26JvG6RUJ23u
As our experience with the one successful form of immunotherapy that is currently used for blood cancer patients, allogeneic transplant, progress tends to be slow in immunotherapy. It took decades to make allo transplant part of upfront therapy for multiple blood cancers. Dr. Stadtmauer did an excellent job of explaining that these therapies are likely a long ways away from being part of front line/early therapy for myeloma patients. Long term toxicities are unknown since there are no long term survivors of anti CD19 CAR t cell therapy.
Mark
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Mark
Re: Cell therapy for leukemia, how about multiple myeloma?
Whoa Mark! Thanks for the detailed response. Very informative.
Re: Cell therapy for leukemia, how about multiple myeloma?
I just finished watching the video of the IMF Patient/Family Conference in Florida that was referenced by Mark. Dr. Stadtmauer is my oncologist and he told me In December, after the ASH conference, that there is one myeloma patient that has received the altered T-cell therapy at Penn. He said that so far that person is doing well. But, he also said that he doesn't feel that the current antigen that is being targeted with that therapy is the one that will be most effective against myeloma. He does think that it will be identified in further research.
You may be able to tell that Dr. Stadtmauer is enthusiastic about what he does. He expressed to me that he feels quite privileged to be working for an institution that does so much research and that has made so many strides in the treatment of cancer. I appreciate having him as my oncologist because of his enthusiasm and his willingness to discuss not only the research that is done at Penn, but myeloma research as a whole.
We have a lot to look forward to as the biology of myeloma becomes better understood and the treatments become more targeted. I may not benefit from the things that are just beginning to be discovered, but I am benefiting from what has been learned up to this point.
Nancy in Phila
You may be able to tell that Dr. Stadtmauer is enthusiastic about what he does. He expressed to me that he feels quite privileged to be working for an institution that does so much research and that has made so many strides in the treatment of cancer. I appreciate having him as my oncologist because of his enthusiasm and his willingness to discuss not only the research that is done at Penn, but myeloma research as a whole.
We have a lot to look forward to as the biology of myeloma becomes better understood and the treatments become more targeted. I may not benefit from the things that are just beginning to be discovered, but I am benefiting from what has been learned up to this point.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Cell therapy for leukemia, how about multiple myeloma?
Updating Mark's detailed post: Dr. Stadtmauer's team at UPenn has started a CAR-T CD19 trial for high risk multiple myeloma patients (those who relapsed within a year of their first ASCT). In the three patients who have received their own genetically modified T cells (following a second ASCT), all are in stringent CR, with active CAR-T cells, and no major side effects.
Dr. Carl June did an excellent job at the ASH meeting on Dec. 7th, 2014, along with Dr. Steven Rosenthal from the NIH, in presenting the state of the art of CAR-T therapy. Following the present pilot study, plans are being made to expand this therapy to other refractory high risk multiple myeloma patients. This is very exciting!
I am privileged to be one of the first three patients to receive this therapy. After running out of all other FDA approved options, I had 2 rounds of VD-PACE chemo, before which my bone marrow was 92% affected with malignant plasma cells. It is wonderful to be off all medications, and having no side effects. The exact type of immunotherapy which will work best for multiple myeloma is yet to be determined, but I am convinced this offers much promise for our enigmatic, ever mutating disease. This therapy really gets at the root of the problem!
Dr. Carl June did an excellent job at the ASH meeting on Dec. 7th, 2014, along with Dr. Steven Rosenthal from the NIH, in presenting the state of the art of CAR-T therapy. Following the present pilot study, plans are being made to expand this therapy to other refractory high risk multiple myeloma patients. This is very exciting!
I am privileged to be one of the first three patients to receive this therapy. After running out of all other FDA approved options, I had 2 rounds of VD-PACE chemo, before which my bone marrow was 92% affected with malignant plasma cells. It is wonderful to be off all medications, and having no side effects. The exact type of immunotherapy which will work best for multiple myeloma is yet to be determined, but I am convinced this offers much promise for our enigmatic, ever mutating disease. This therapy really gets at the root of the problem!
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Jan Stafl - Name: Jan Stafl MD
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: July 2011
- Age at diagnosis: 54
Re: Cell therapy for leukemia, how about multiple myeloma?
Hi Dr. Stafl,
Congrats on the GREAT News!!!!
I just mentioned you in another thread. This was definitely the news I wanted to hear.
https://myelomabeacon.org/forum/ric-allogeneic-stem-cell-transplants-t4471.html
Mark
Congrats on the GREAT News!!!!
I just mentioned you in another thread. This was definitely the news I wanted to hear.
https://myelomabeacon.org/forum/ric-allogeneic-stem-cell-transplants-t4471.html
Mark
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Mark11
Re: Cell therapy for leukemia, how about multiple myeloma?
Thank you, Mark, for your reply. Yes, I am very glad I found the CAR-T trial at UPenn. It has already been worth it for me to fly across country from my home in Eugene OR to Philly for 6 weeks, with my wife who has been a devoted caregiver. Really, I only had four viable options for treatment this fall: this trial, some other clinical trials (involving monoclonal antibodies or other combination therapies), a salvage allo transplant, or continued cytotoxic chemo (VD-PACE).
So it was a no brainer for me to decide on this UPenn trial. It has worked out very well for the first three patients. Of course it is too early to say what the long term outcome will be for any of us, but intuitively and scientifically, I believe this approach (or similar targeted immunotherapy) is the long term answer to refractory multiple myeloma.
I waited to post till Dr. Carl June from UPenn presented at ASH in SF on Sunday (12/7/14), where for the first time he presented our preliminary data, and the rationale for this therapy in multiple myeloma. The team here has been excellent! Now a more inclusive trial is being planned. Stay tuned! Five companies and research centers are competing to be first with FDA approval, initially no doubt with acute lymphocytic leukemia (ALL). I truly believe that CAR-T CD19 is the best target.
Best wishes! Jan
So it was a no brainer for me to decide on this UPenn trial. It has worked out very well for the first three patients. Of course it is too early to say what the long term outcome will be for any of us, but intuitively and scientifically, I believe this approach (or similar targeted immunotherapy) is the long term answer to refractory multiple myeloma.
I waited to post till Dr. Carl June from UPenn presented at ASH in SF on Sunday (12/7/14), where for the first time he presented our preliminary data, and the rationale for this therapy in multiple myeloma. The team here has been excellent! Now a more inclusive trial is being planned. Stay tuned! Five companies and research centers are competing to be first with FDA approval, initially no doubt with acute lymphocytic leukemia (ALL). I truly believe that CAR-T CD19 is the best target.
Best wishes! Jan
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Jan Stafl - Name: Jan Stafl MD
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: July 2011
- Age at diagnosis: 54
Re: Cell therapy for leukemia, how about multiple myeloma?
Congrats Jan, for that is awesome news!! Good to hear that you are a pioneer in a therapy that is working well for you. Hope all continues to go well!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Cell therapy for leukemia, how about multiple myeloma?
Not to sound stupid here, but what does this therapy entail? Is it a transplant of some sort?
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Guest1
Re: Cell therapy for leukemia, how about multiple myeloma?
Jan-
Congratulation on being one of the people who has done the CART-19 trial with multiple myeloma. I pray that your response continues to be good.
I attended the recent Blood Cancer Conference for patients and families sponsored by the Abramson Cancer Center (Penn) and the local LLS. Dr. Porter, who is doing the actual CART-19 treatment, spoke at the conference about the trial, how many patients have received the treatment, what blood cancers it is being trialed with, the response rate, etc. The second leukemia patient to receive the treatment was there and has been cancer free for over 4 years. Myeloma patients are now being included in the trial at Penn. The response rate for the various leukemia diagnoses has been amazing.
Guest 1-
CART-19 is a trial where genetically altered T-cells from the patient are infused back into the patient. They T-cells have been altered to attach to a specific antigen on the surface of the cancer cell to interrupt the life cycle of the cancer cell. The T-cells are collected in the same way that our stem cells are harvested, by filtering out the T-cells from the blood through apheresis.
In the other blood cancers the altered T-cells are infused into the patient with no other treatment required. It can be done as an office visit. With Myeloma patients there is a more involved process. Dr. Stadtmauer explained that there aren't very many of the targeted antigens on the Myeloma cell. So, the person goes through a stem cell transplant first to knock out the Myeloma cells. Then the altered T-cells are infused to attach to the targeted antigens that are in good number on the precursor Myeloma cells, Myeloma stem cells (?)
So far the altered T-cells appear to multiply once they have been infused into the body. They show up in the blood for many weeks following the infusion. So, they are continuing to do their job in eliminating the cancer cells. In the leukemia patients they tend to have a very strong reaction about 3 weeks post infusion due to the number of dead cancer cells that are in the person's system that need to be eliminated. Supportive care has been successful in getting people through this reaction. After recovery from that, which seems to take a few days, the people have had no, to little, evidence of any cancer cells in their bodies.
This is a very exciting time in the treatment of the various blood cancers. The fact that this is now being trialed with people with Myeloma is really exciting to me. The blood cancer doctors, including the 5 Myeloma specialists, at Penn are beside themselves with hope, wonder and delight that so far this treatment is proving viable.
You might still be able to view Dr. Porter's talk about the CART-19 trial on Oncolink.org. It was broadcast live during the conference on Nov. 21, 2014.
Nancy in Phila
Congratulation on being one of the people who has done the CART-19 trial with multiple myeloma. I pray that your response continues to be good.
I attended the recent Blood Cancer Conference for patients and families sponsored by the Abramson Cancer Center (Penn) and the local LLS. Dr. Porter, who is doing the actual CART-19 treatment, spoke at the conference about the trial, how many patients have received the treatment, what blood cancers it is being trialed with, the response rate, etc. The second leukemia patient to receive the treatment was there and has been cancer free for over 4 years. Myeloma patients are now being included in the trial at Penn. The response rate for the various leukemia diagnoses has been amazing.
Guest 1-
CART-19 is a trial where genetically altered T-cells from the patient are infused back into the patient. They T-cells have been altered to attach to a specific antigen on the surface of the cancer cell to interrupt the life cycle of the cancer cell. The T-cells are collected in the same way that our stem cells are harvested, by filtering out the T-cells from the blood through apheresis.
In the other blood cancers the altered T-cells are infused into the patient with no other treatment required. It can be done as an office visit. With Myeloma patients there is a more involved process. Dr. Stadtmauer explained that there aren't very many of the targeted antigens on the Myeloma cell. So, the person goes through a stem cell transplant first to knock out the Myeloma cells. Then the altered T-cells are infused to attach to the targeted antigens that are in good number on the precursor Myeloma cells, Myeloma stem cells (?)
So far the altered T-cells appear to multiply once they have been infused into the body. They show up in the blood for many weeks following the infusion. So, they are continuing to do their job in eliminating the cancer cells. In the leukemia patients they tend to have a very strong reaction about 3 weeks post infusion due to the number of dead cancer cells that are in the person's system that need to be eliminated. Supportive care has been successful in getting people through this reaction. After recovery from that, which seems to take a few days, the people have had no, to little, evidence of any cancer cells in their bodies.
This is a very exciting time in the treatment of the various blood cancers. The fact that this is now being trialed with people with Myeloma is really exciting to me. The blood cancer doctors, including the 5 Myeloma specialists, at Penn are beside themselves with hope, wonder and delight that so far this treatment is proving viable.
You might still be able to view Dr. Porter's talk about the CART-19 trial on Oncolink.org. It was broadcast live during the conference on Nov. 21, 2014.
Nancy in Phila
-
NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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