What is the Black Swan Research Initiative's immune system study to understand early myeloma development? 

This week's "Ask Dr. Durie" comes from a patient who has heard about the Black Swan Research Initiative and wants to know, well, what could be an example of one of the more exciting new projects that is being conducted by the Black Swan investigators? So, a very good question. We have a number of exciting initiatives underway right now. 

The one that I would perhaps highlight first here is a study of the immune system in patients with early disease. And so, this is a study in which samples are taken from patients who have monoclonal gammopathy of undetermined significance, MGUS, or early smoldering myeloma. And those are patients who are in the earliest stages of the process toward what can ultimately become active myeloma. 

And by studying the immune system in the bone marrow and in the blood of these patients, we can understand what are the regulators? What are the potential immune defects that are leading to the development of the MGUS in the first place? And then the immune defects that allow the disease to progress, first to smoldering and then to active myeloma. 

And so, I'm excited about this because our initial studies have already shown that at the very, very earliest point of the disease, there are immune defects detectable in the microenvironment around the cells in the bone marrow and also present in the blood. And so, these defects involved the T cells, the immune cells, reductions of normal B cells, and K cells, and macrophages. 

A number of different immune cells are affected by this immune defect. And it seems that this defect is what allows the initiation of the disease and the progression of the disease. And so, this is quite exciting to understand and to document. 

And, this is particularly important because if we can understand these immune defects, we can offer interventions, we can offer treatments and ways to correct these immune defects and perhaps if we are very lucky, make some corrections that would stop MGUS from happening, or certainly more likely that we could stop MGUS from progressing to smoldering or to active myeloma. 

And so, BOTTOM LINE is that there are many Black Swan Research Initiative projects ongoing, but I think that this one has the greatest long term potential. Because it will allow us to understand the very, very earliest beginnings of MGUS and smoldering, which can lead to active myeloma. And by understanding more clearly, this early process, particularly in terms of the immunology of the microenvironment, we have the opportunity to intervene, and be successful at this very, very early point in the disease process.