Good morning, myeloma world.

We hope your week is getting off to a good start. We've got a couple of new research studies to discuss in today's edition of Myeloma Morning ^[1], as well as several highlights from the Beacon's discussion forum.

On the research front, we'll start today by mentioning an article by physicians at the Mayo Clinic's Arizona campus. They report on a com­pli­ca­tion, known as thrombotic microangiopathy (TMA), that occurred in two multiple myeloma patients they had treated with Kyprolis (car­filz­o­mib) (abstract ^[2]).

TMA is a con­di­tion marked by the formation of blood clots in the small arteries and capillaries of the body. One specific type of TMA is thrombotic thrombocytopenic purpura (TTP). Former Myeloma Beacon columnist Pat Killingsworth ^[3] developed TTP prior to his passing last month (see related Beacon ^[4] news article). Pat was being treated with Kyprolis at the time.

The Mayo Clinic researchers attempted to address the TMA that developed in their patients by carrying out thera­peutic plasma exchange, also known as thera­peutic apheresis, which removes components of a patient's blood from their body. Plasma exchange, however, was not a beneficial treat­ment. The cases of TMA only resolved after dis­con­tinu­a­tion of the Kyprolis treat­ment.

Today's list of new research also includes a look at the potential mechanisms by which the drug roneparstat (SST0001) may be able to improve the treat­ment of multiple myeloma (full text ^[5]). Roneparstat is an investi­ga­tional drug being developed by the Swiss com­pany Sigma Tau Research. A Phase 1 trial of the drug ^[6] in myeloma patients is ongoing in Europe, and an initial report from the trial was presented at last year's American Society of Hematology annual meeting (abstract ^[7]).

In the new study, whose authors include scientists employed by Sigma Tau, researchers discuss laboratory findings showing how the enzyme heparanase may encourage the growth and spread of cancer tumor cells, including myeloma cells. The researchers also report findings indicating that myeloma ther­a­pies such as Velcade (bor­tez­o­mib) and Kyprolis can encourage myeloma cells to produce heparanase.

Roneparstat, on the other hand, is heparanase inhibitor. It limits the amount of heparanase that cells can absorb, both on its own, and when used in com­bi­na­tion with other myeloma ther­a­pies. The extent to which this effect has a significant impact on myeloma cells, however, will need to be determined through addi­tional clinical testing of the drug in myeloma patients.

The final new research article we want to mention is a report by researchers in China. They have in­vesti­gated a protein known as SPRY2 (also called “sprouty2”), which the human body naturally produces. The Chinese researchers carried out laboratory experiments to assess whether SPRY2 has any influence on multiple myeloma cells. They found that SPRY2 can inhibit the growth and survival of multiple myeloma cells. This means new drugs that stimulate the pro­duc­tion of SPRY2, or act in ways similar to SPRY2, could be used as new treat­ments for multiple myeloma (abstract ^[8]).

(The research into the impact of SPRY2 on myeloma cells is influenced by earlier research into the impact of an area of the human genome known as microRNA 21, or miR-21, on myeloma cells and how resilient they are. If you are interested in the subject, this paper ^[9] in­ves­ti­gates the potential connection between miR-21 and SPRY2.)

The trend con­tinues here at Myeloma Morning in terms of there being no new business-related news to report. The trend also con­tinues, however, in terms of there being quite a bit of recent activity in the Beacon discussion forum. Here are a few of the ongoing forum discussions we thought worth highlighting:

• Gary, an 18-year myeloma survivor, asks others in the forum what can be done to help the caregivers ^[10] who give so much to support multiple myeloma patients
• Debbie keeps on going just like that famous battery bunny; she has provided an update about Days 9 and 10 ^[11] of her autologous (own) stem cell transplant
• Lynda gives a lengthy introduction to how her husband, who is 72, was just diagnosed with multiple myeloma ^[12]. He will be treated with Velcade, cyclo­phos­phamide (Cytoxan), and dexamethasone
• KarenaD will soon have her autologous stem cell transplant. She is wondering when people usually have their stem cells reinfused ^[13] during the transplant process.

New myeloma-related research articles

1. Qaqish, I. et al., “Carfilzomib: a cause of drug associated thrombotic microangiopathy” in Transfusion and Apheresis Science, March 15, 2016 (abstract ^[2])
2. Ramani, V. C. et al., “Chemotherapy induces expression and release of heparanase leading to changes associated with an aggressive tumor phenotype” in Matrix Biology, March 22, 2016 (full text ^[5])
3. Yao, Y. et al., “Sprouty2 regulates proliferation and survival of multiple myeloma via inhibiting the activation of ERK1/2 pathway in vitro and in vivo” in Experimental Biology, March 22, 2016 (abstract ^[8])