New Guidelines for Superior Imaging, a Possible Cause of Post-Transplant Relapse, and the Future of Genetic Therapy: Myeloma News in Brief

  • October 11, 2018

    New Guidelines for Superior Imaging, a Possible Cause of Post-Transplant Relapse, and the Future of Genetic Therapy: Myeloma News in Brief

    WRITTEN BY: Brian GM Durie MD

Blogs Posts

As part of its mission to establish guidelines for myeloma treatment and diagnosis, the International Myeloma Working Group (IMWG) has just published guidelines for whole-body low-dose CT, an imaging modality for bone disease assessment. This new, open-access report in Blood Cancer Journal  is extremely helpful in explaining the value of whole-body low-dose CT (WBLDCT) and justifying reimbursement for its use.

There is little doubt that WBLDCT is preferable to standard X-rays (so-called skeletal survey). WBLDCT can detect bone lesions in more than 20 percent of patients when standard X-rays are normal/negative. Clearly more sensitive! This is particularly important because evidence of bone destruction is a definite indication to start or restart treatment. In addition, WBLDCT is widely available, relatively cheap, and patient-friendly (scanning in a few minutes) compared to extended MRI evaluation, for example.

The IMWG report has immense practical value. It describes in detail how to perform the scans and how to report the results. It is hoped these guidelines will accelerate the switch from standard X-rays to CT. Patients can alert their treating physicians to the availability of this reference document.

Clue to post-transplant relapse?

Another interesting and helpful new publication documents for the first time that relapse after autologous stem cell transplantation (ASCT) may be caused by what is called “immune (T cell) exhaustion.” This is an extremely valuable concept since it alerts us to the potential value of reinvigorating the immune response. If activated, the T cells can control residual disease. With all the new immunotherapies, such as CAR T cells and bispecific (BiTES), MoAbs (BCMA / T cell), in clinical trials now, this is really good news. More work is needed to test this notion in clinical trials.

Genetic therapy of the future

A report documenting cure for a genetic disorder in mice using CRISPR technology at Children’s Hospital of Philadelphia and written up in Stat is an important proof of principle. In this case, the disease is a fatal liver disease. A relatively new base (gene nucleotide) editing technique was used. There has been concern that such gene editing could wreak havoc due to “off-target effects” –changing genes in addition to the bad gene. But the gene substitution worked, and the mice lived into adulthood. Can this type of technique be used in the treatment of myeloma? Probably yes, but not for a few years! This is a glimpse of the genetic-therapy future.

Impactful nutrition and environmental news

And finally, a mixture of good and bad news that is somewhat of a red alert for the future. The U.S. Food and Drug Administration (FDA) banned the use of seven synthetic chemicals in food. These chemicals are: benzophenone, ethyl acrylate, methyl eugenol, myrcene, pulegone, and pyridine—all of which you have probably never heard of! But these chemicals, which mimic natural flavorings, are widely used in processed foods and are strongly linked to cancer in animals. The FDA followed a 1938 law, which bans chemicals that cause cancer in animals as food additives. Although this is very reasonable, it is wonderful to see the FDA honoring this important law. The basic principal is: do no harm.

In stark contrast, the U.S. Environmental Protection Agency (EPA) continues to NOT respect data that points to serious toxicity that can affect health and potentially cause cancer. Despite a new study indicating the serious dangers of exposure to the weed killer Roundup, the EPA maintains that Roundup is safe. The recent study suggests that Roundup may be what is wiping out honey bees in a “colony collapse.” This is obviously horrible in itself, but also strongly supports the conclusion that Roundup is NOT safe. Simultaneously, the EPA is eliminating the office that advises on science and has removed the children’s health specialist, Dr. Ruth Etzel, a highly respected pediatric scientist who advises on the most vulnerable group of all. In addition, a new United Nations report on climate change was released with no comments from the EPA, despite dire warnings about both the environment and health.

*Update: The EPA will disband a key scientific review panel on air pollution, The New York Times reports.  The Particulate Matter Review Panel helps the agency determine what level of pollutants (carbon monoxide, particulate matter, nitrogen oxides, sulfur dioxide, lead, and ozone) are safe to breathe, a critical public health function as the agency considers whether to revise the nation’s air quality standards.

This is where Myeloma Warriors can kick in! They can help raise awareness of both the exciting news for the future, as well as potential risks. The Warrior-in-Chiefs among us must be alert, and ready to guide the way forward about what to seek out and what to avoid—a critical role for ensuring good health for us all.

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF InfoLine staff instead. Specific medical questions posted here will be forwarded to the IMF InfoLine. Questions sent to the InfoLine are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate, but will not be posted here. To contact the IMF InfoLine, call 800-452-CURE, toll-free in the US and Canada, or send an email to InfoLine hours are 9 am to 4 pm PT. Thank you.