Multiple myeloma treatment: A roadmap for long-term care 

Multiple myeloma is the second most common hematologic malignancy in the United States, with about 35,000 new cases diagnosed each year. Although the condition currently has no cure, some patients have been known to achieve long-term remission.

Recent research breakthroughs have expanded treatment options, bringing hope to managing the complex disease, explains Shivani Kapur, MD, Assistant Professor of Clinical Medicine in Hematology-Oncology at Penn Medicine, in a recent episode of the Penn Medicine Physician Interviews podcast.

“Myeloma is heterogeneous and complicated, and as our treatments are evolving, including specialists early on in the treatment course can make a real difference,” Dr. Kapur says. “We can help create a roadmap for patients for their long-term care.”

Multiple myeloma treatment landscape

Treatment for myeloma typically involves a four-drug regimen followed by an autologous stem cell transplant and maintenance drug therapy. But the treatment journey can vary between patients.

“With myeloma treatment, there really isn't a one-size-fits-all approach,” Dr. Kapur says. Instead, physicians consider patient- and disease-specific factors such as age, organ function, overall fitness, and cytogenic risk, which indicates the cancer’s aggressiveness.

New treatments are also factoring into treatment decisions. In recent years, a number of therapies for myeloma have been approved, including new immunotherapies such as CAR T cell therapy and bispecific antibodies. As evidence of their benefit accumulates, these treatments are being used more broadly, explains Adam Cohen, MD, Associate Professor of Medicine in the Division of Hematology-Oncology and Director of Myeloma Immunotherapy at Penn Medicine, on the podcast.

“We have all of these new exciting therapies, and we’re starting to move some of them into the consolidation/maintenance setting after initial therapy,” he says.

CAR T cell therapy for multiple myeloma

CAR T therapy has been a particularly important development in myeloma treatment. Researchers at Penn Medicine were involved in some of the early trials that led to the its approval for myeloma.

Those trials found impressive response rates, especially in patients with relapsed disease, Dr. Cohen says. Some late-line patients treated with CAR T experience durable remissions lasting five years or more.

Now, CAR T therapy is beginning to be used earlier in the treatment process. Outcomes may be even better for those patients, with one large, randomized trial showing an overall survival advantage.

“While we are not convinced that CAR T cell therapy is curative for multiple myeloma at this point, we see these prolonged remissions,” Dr. Cohen says. “The future of CAR T is really bright.”

Multiple myeloma clinical trials and care at Penn Medicine

Penn Medicine researchers are actively involved in myeloma research, including projects to understand what contributes to durable remissions and how best to treat patients who relapse. Penn Medicine also provides patients with access to many clinical trials, such as recent trials exploring bispecific antibodies in combination with CAR T treatment and other immunomodulatory agents.

Between new drug combinations, newer CAR T therapy products, and research to use T cell therapy earlier in the treatment journey, there is hope that multiple myeloma patients might move out of the “durable remission” category and into the “cure” category.

“We hopefully have the tools now, and we just have to figure out the right way to put them all together,” Dr. Cohen says. “This is a really exciting time [for myeloma research], and it’s another reason that referral to a myeloma specialty center can be helpful.”

At Penn Medicine, this specialty care also provides access to a large and dedicated multidisciplinary team of physicians, advanced practice providers, pharmacists, social workers, and nurse navigators who help guide patients through their treatment journey.

“With myeloma therapy, there are a lot of logistical considerations that really require a very large multidisciplinary team,” Dr. Kapur says.

That care team collaborates with referring physicians to provide patients with the highest level of treatment and continuity of care. “We look forward to working with our partners in the community to make comprehensive care plans for our patients so that they’re able to get some of these treatments close to home,” she adds.

Clinical consult and patient referral

Shivani Kapur, MD, and Adam Cohen, MD, see patients at the Penn Medicine Abramson Cancer Center in Philadelphia, PA. For a provider-to-provider consultation with Drs. Kapur and Cohen, call 877-937-7366, or refer a patient online.

Associated Resources

Episode: Navigating Multiple Myeloma: A roadmap for long-term care

Drs. Adam Cohen and Shivani Kapur lay out a roadmap for the treatment journey for patients with multiple myeloma, from early treatment options to recent advances in immunotherapy, combination maintenance therapies, and clinical trials.

Listen to this episode on Apple Podcasts, Spotify or YouTube Music.