5-year study shows long-lasting remissions, suggests possible “cure”
Multiple myeloma has long been a challenging diagnosis to treat. Even after achieving remission, the disease has a tendency to recur and patients often need long-term therapy.
But for the first time, doctors are finding a course of treatment that might result in what could be considered a cure.
Ehsan Malek, MD, Director of Multiple Myeloma Translational Research at Roswell Park Comprehensive Cancer Center, says a recent study involving CAR T-cell therapy at the first relapse yielded no measurable residual disease (MRD) after five years.
“In multiple myeloma, one of the key problems is that the immune system no longer ‘sees’ myeloma cells, allowing the cancer to grow unchecked,” he says. “CAR T-cell therapy changes that. We collect a patient’s own immune cells and genetically reprogram them to recognize a specific target on myeloma cells. After a single infusion, these modified cells multiply in the body and provide ongoing surveillance, actively seeking and destroying myeloma cells.”
As a result, the patient’s immune system is once again able to detect and respond to the cancerous cells, eliminating the need for additional chemotherapy. “It is a paradigm shift from the traditional way of treating myeloma, which is continuous chemotherapy,” Dr. Malek says, adding that this treatment is available to patients at Roswell Park.
A new study for multiple myeloma treatment
The study, called CARTITUDE-1, used an FDA-approved drug, ciltacabtagene autoleucel (cilta-cel), administered to 97 patients between with advanced multiple myeloma 2018 and 2019. After five years, 32 of those patients (almost one-third of treated patients) had no sign of the disease returning, meaning they needed no further treatment. Most of those patients had no measurable residual disease, meaning no detectable cancer in their bone marrow or bloodstream, even with the most highly sensitive tests.
“In a detailed analysis of 12 patients at one center, every single patient remained MRD-negative at five years,” Dr. Malek says. “It’s the deepest remission we can measure and a strong predictor of long-term disease control. It’s also the first time in myeloma history that researchers can seriously discuss the possibility of a cure, even if it’s just for a subset of patients.”
Cilta-cel has been used in patients who have prior treatment for their multiple myeloma and are in their first relapse, with additional studies now exploring whether it could be used earlier in the course of the disease, Dr. Malek says. “The hope is that earlier use will lead to even more long-term remissions and perhaps more cures.”
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Treatment focuses on getting you into remission, with minimal residual disease, and extending the duration of the remission — achieving this requires the knowledge of doctors who are experts in the field.
