Multiple Myeloma: What to Know About this Blood Plasma Cancer

Its name doesn’t announce right up front that it’s a cancer or signal its location like, say, breast cancer or prostate cancer do, so it may sound fairly innocuous. But multiple myeloma is a serious type of blood cancer that affects blood plasma cells, a critical part of your body’s immune system.

Normal plasma cells are found in your bone marrow. They make the antibodies, also called immunoglobulins, that help your body attack and kill germs, according to the American Cancer Society (ACS). “When plasma cells become cancerous and grow out of control, they make an abnormal protein, or antibody, known by several different names, including monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike or paraprotein,” the ACS says.

George Nahas, D.O., a medical oncologist with Baptist Health Miami Cancer Institute, specializes in bone marrow transplants and cellular therapy for multiple myeloma, leukemia and lymphoma patients. He says a diagnosis of multiple myeloma is confirmed by a number of tests not limited to a bone marrow biopsy and imaging.

George Nahas, D.O., a medical oncologist with Baptist Health Miami Cancer Institute

In addition, Dr. Nahas has been incorporating chimeric antigen receptor T-cell therapy, more commonly known as CAR-T cell therapy, in the treatment of patients with multiple myeloma who qualify for the therapy. An advanced type of immunotherapy, CAR-T cell therapy has been approved by the U.S. Food and Drug Administration (FDA) for treating blood cancers, including lymphomas, some forms of leukemia, and, most recently, multiple myeloma.

How CAR-T cell therapy works

With CAR-T cell therapy, the patient’s T-cells, a type of white blood cell, are collected and genetically modified to include a new marker that targets and kills the cancer cells, Dr. Nahas explains. Once the cells have been modified, they are infused back into the patient, where they have the ability to eradicate multiple myeloma or lymphoma and prevent recurrence.

“Through a process called transduction, we introduce a genetic blueprint into the patient’s T-cell that holds the recipe for making a new T-cell with a receptor specifically targeting their multiple myeloma cells,” says Dr. Nahas. “We’re essentially creating supercharged T-cells in the lab from the patient’s own T-cells, genetically programmed to attack their specific cancer.” 

An ‘amazing’ immunotherapy

For many years, the only treatment for multiple myeloma was corticosteroid therapy with dexamethasone or prednisone, explains Dr. Nahas. He notes that they remain an important part of treating the disease today and are combined with other drugs as a part of treatment regimens. 

“Over the past decade or so there has been an amazing expansion of available therapies for multiple myeloma, which we have the fortune to be able to give our patients at MCI,” Dr. Nahas says.

He adds that every type of immune therapy is available at MCI for our multiple myeloma patients. “CAR-T cell in particular has worked so well that we are looking to see them in earlier lines of therapy at this time and the FDA will be making decisions on this in the near future,” Dr. Nahas says. “Once that happens, CAR-T cells will be able to be used in earlier lines of therapy, possibly in second or third line.”

Multiple myeloma’s wide-ranging effects

Multiple myeloma can cause patients to experience symptoms related to low blood counts; bone and calcium problems; infections, and kidney problems, says the ACS. 

A shortage of red blood cells, which carry oxygen to all of tissues, can cause anemia, leading to weakness and fatigue, while a shortage of white blood cells, which are the basis of the immune system, can cause leukopenia, impacting the body’s ability to fight infections. Multiple myeloma can also cause the level of platelets in the blood to become low – a condition called thrombocytopenia – which can lead to increased bleeding and bruising.

Fractured bones are a major problem for people with myeloma, the ACS says, because myeloma cells interfere with healthy cells that help replace bone and keep them strong. As a result, old bone is broken down without new bone being made to replace it. This makes bones weak and easy to break and it can also raise calcium levels in the blood. 

Infections are also a concern for people with multiple myeloma because the abnormal myeloma cells, which are unable to protect the body from infections, crowd out normal plasma cells. Also, the ACS states, myeloma cells make an antibody that can harm the kidneys, leading to kidney damage and even kidney failure.

Possible side effects of CAR-T Cell therapy

Patients with multiple myeloma who are being treated with CAR-T cell therapy require careful monitoring, especially during the first two weeks or so, says Dr. Nahas. 

“CAR-T cell therapy has a totally different type of toxicity profile than chemotherapy,” he notes. “It can cause cytokine release syndrome, or a cytokine storm, in which the infused cells release cytokines and trigger an overwhelming inflammatory response syndrome that can mimic the symptoms of sepsis or septic shock.” These include fever, tachycardia (rapid heartbeat), hypotension (low blood pressure) and multiple organ system dysfunction.

Another possible concern with CAR-T cell therapy is its potential for neurotoxicity, which can cause confusion in some patients, another reason for careful monitoring by a professional team in this acute setting. Even when patients return home from the hospital, they are closely monitored, coming into the clinic once or twice a week at first and then every four to six weeks.

Extensive experience with blood cancers

One of the advantages of seeking treatment for multiple myeloma at Miami Cancer Institute, Dr. Nahas says, is its extensive experience with blood cancers in general and multiple myeloma in particular. “We have lots of experience here, starting with Guenther Koehne, M.D., Ph.D., the Institute’s deputy director and chief of Blood & Marrow Transplantation and Hematologic Oncology,” he says.

Dr. Nahas also points to the number of clinical trials which Miami Cancer Institute’s physician-researchers are either leading or participating in. “We not only have every commercially available therapy for treating multiple myeloma here, we’re also actively seeking new and even more effective therapies every day.”