An exciting approach to refractory myeloma is the development of CAR-T cells to recognize and kill the malignant plasma cells which mutate and are responsible for recurrence. Chimeric Antigen Receptor - T cell therapy has now been used in hundreds of patients with recurrent leukemia (89% success) and chronic lymphoma (~50% success), and is on fast tract for FDA approval. Now a few top institutions are using it for refractory, heavily pretreated myeloma.
The process involves an apheresis of one's own T cells, then genetically modifying them using a HIV virus vector to recognize surface antigens, be it CD19, CD38, or C138. They are then reinfused back into the patient, following engraftment of stem cells after a second autologous transplant, or not.
After studying my own options for my refractory myeloma, I have chosen to participate in the UPenn CAR-T CD19 clinical trial. I just finished the procedure on Nov.18th, following my second ASCT. Having recovered from the side effects of the second transplant, the reinfusion of my own CAR-T cells 13 days after was asymptomatic. Now I have to wait for evidence of efficacy with frequent labs and f/u bone marrow biopsy. Two women have preceded me in this trial, both of which are apparently doing great. I am the first male, and the plan here is for monthly patients for the first year.
I am convinced that some type of immunotherapy is the key to the Holy Grail of MM research, dare I call it cure. The devil is in the details, of course, and we need more institutions to open up these trials, and more patients to take advantage of them. Stay tuned; data from these trials may be very promising, and available in 2015!
Best wishes to all fellow MM patients! Jan H. Stafl MD