COMMENTARY

Cellular Immunotherapy for Multiple Myeloma Advancing Rapidly

Theodore Bosworth

Disclosures

January 30, 2017

In This Article

Potentially curative therapies for multiple myeloma (MM) based on various methods of adoptive immune cell transfer are advancing rapidly in clinical trials. The activity of these strategies in the clinical setting, although experimental, can no longer be considered hypothetical. At the 2016 annual meeting of the American Society of Hematology (ASH), responses reported in small trials were been dynamic and sustained, and the data promise a major evolution in standard MM treatment strategies.

"The age of cellular immunotherapy for myeloma is upon us," said Edward A. Stadtmauer, MD, chief of the hematologic malignancies section at University of Pennsylvania, Philadelphia. A lead- or coinvestigator on several of the MM immunotherapy studies presented at the 2016 ASH annual meeting, Dr Stadtmauer was also a panelist on an educational session that collated and summarized current data. The message, from that specific session as well as from the newly reported data overall, is that this direction of research is moving very quickly.

The promise of cell-based immunotherapy is indefinite disease control or cure.

MM is a disease largely confined to the bone marrow, an environment where it is easy to envision active immune cells attacking and eliminating neoplastic plasma cells. The most effective currently approved therapy for MM, stem cell transplant (SCT), provides a proof of principle that sustained disease control can be achieved when the bone marrow is cleared of malignancy. The clinical results, along with a wave of new strategies—including activated marrow-infiltrating lymphocytes (MILs), chimeric antigen receptor (CAR) T cells, and T cells transduced with receptors (TCRs) to MM antigens—are striking.

New data with two of these strategies were presented at the ASH annual meeting. All three build on the concept of adoptive cell transfer. With modifications to improve MM specificity, each has been associated with clinical responses in refractory diseases, including complete response (CR). Perhaps most encouraging, there is evidence that the modified immune cells may persist to provide sustained antimyeloma activity. This is an important departure from SCT, after which most patients eventually relapse. The promise of cell-based immunotherapy is indefinite disease control or cure.

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