Myeloma UK is dedicated to working with healthcare professionals and researchers in myeloma, to help us improve care, find new treatments and get closer to our ultimate goal of finding a cure.
Dr Jonathan Carmichael, a Myeloma Clinical Research Fellow working at St James University Hospital in Leeds benefits in part from funding by Myeloma UK.
Jonathan is passionate about the immune system and looking at myeloma in particular. He tells us a little bit about his research interests and some of the most exciting research currently happening in the myeloma field.
Dr Carmichael’s research
My research is looking at how the immune system changes throughout the course of myeloma. The immune system is made up of a vast array of cells that protect the body from foreign invaders such as bacteria and viruses, as well as dead or diseased cells, including cancer cells. However, cancer cells, including myeloma cells, can evolve so that they are not recognised and destroyed by the immune system.
Understanding how the immune system differs in myeloma patients is essential for the development of new treatments that will improve the immune system’s response against myeloma cells.
In my research, I look at the immune systems of patients at different stages of myeloma. This involves separating and counting the different cell types and looking at the genetic sequences of the cells to determine how similar they are, whether sequences are shared between patients, and whether certain genetic sequences predict how a patient will respond to treatment.
We hope to be able to use this project as a stepping stone towards the creation of simple blood tests that will be able to examine the immune system and help to predict the best treatment choices for patients.
It is a very exciting time to be involved in myeloma research, with new therapies around the corner that have the potential to revolutionise outcomes for patients. I attended the 59th American Society of Haematology Annual Meeting and Exposition (ASH) last December, which provided me with an opportunity to hear about the latest developments in myeloma treatment.
There is currently huge excitement around the use of CAR-T cells in myeloma. This treatment involves modifying a patient’s own T-cells, which are part of the immune system so that they can more successfully identify and destroy myeloma cells. The major benefit of targeted treatment is that it reduces the chances of so-called ‘off-target’ side-effects, which impact healthy, non-cancerous cells.
Results from an American Phase I trial studying a CAR-T cell therapy known as bb2121 were presented at ASH. The patients involved in this study all had advanced myeloma and had received an average of 7 previous treatments, including stem cell transplantation. Despite this, 94% of patients showed some response to a single infusion of CAR-T cells, and several patients remained in complete remission for 6 months after treatment.
This study highlights the potential of this type of treatment and it will be very exciting to see how things progress through later stage clinical trials.
Further information about CAR-T cell therapy is available here.
A recent clinical trial in the UK looked at the effect of adding daratumumab (Darzalex®) to the treatment combination, VMP, which consists of bortezomib (Velcade®), melphalan and prednisone.
VMP is often used to treat newly diagnosed myeloma patients who are not eligible to have a stem cell transplant. Daratumumab is a new drug, known as a monoclonal antibody that works in a different way to the drugs in VMP. It has recently been approved for use on the NHS for relapsed and refractory myeloma patients.
The results of this study show that patients who received daratumumab had a longer period of time before relapse. In addition, there were no significant additional side-effects reported in these patients, demonstrating that this combination is safe.
These results are promising as they show that adding daratumumab to existing treatment combinations can improve outcomes for patients who are not able to undergo a stem cell transplant.
Further information about daratumumab is available here.
Another presentation focused on results from a large UK-based trial, known as Myeloma XI. Part of this trial was looking at the benefit of using lenalidomide (Revlimid®) as maintenance treatment in newly diagnosed patients.
Maintenance treatment is the name given to treatment which is given over an extended period of time after the main treatment has finished, often at a lower dose, to prolong remission.
The researchers found patients who received the lenalidomide maintenance treatment had a longer period of remission, and this was true for both patients who received a stem cell transplant and those who didn’t.
The positive results from this study are potentially important for UK patients as lenalidomide maintenance is not currently approved by the NHS. These results provide further evidence for the National Institute for Health and Care Excellence (NICE) when considering whether this form of treatment should be funded in the future.
Further information on lenalidomide can be found here.
Personal research highlights
My personal highlight from ASH was a piece of research in a similar field to my own work. This research looked at the immune systems of 20 patients treated with daratumumab (Darzalex®) and immunomodulatory drugs, in this case lenalidomide (Revlimid®). Using genetic sequencing, the researchers identified particular genetic patterns within immune cells that were associated with a good response to treatment.
These results are exciting as they show the potential of genetic sequencing in helping to identify the best treatments for individual patients in the future.