By Claudia Paba Prada, MD

For more than 30 years, oncologists have used immunotherapy to treat cancer, harnessing the strength of the patients own immune system to fight the disease. For many, it has been a welcome alternative or supplement to more traditional chemotherapy, radiation, and surgical options.

The disease I specialize in, multiple myeloma, has no cure, but patients can maintain quality of life with treatment combinations. These individuals have cancer cells form in plasma cells within bone marrow, crowding out healthy (red and white) blood cells and damaging bones, the immune system, and kidneys. We use immunotherapy in combination with chemotherapy to treat cancerous plasma cells, transitioning to different drugs when the cancer mutates and becomes resistant to the previously prescribed treatment. Our goal is to get patients to a stem cell transplant or, if they arent an appropriate candidate, to utilize a combination of drugs to kill myeloma cells. We then continue maintenance therapy to keep cancer cells dormant and preserve their existing lifestyle.

Its critical that we never stop studying the biology of the diseases we see, since each patient is different and there is no one-size-fits-all treatment. What approaches have been used previously, their toxicity, and the patients comorbidities (diabetes, heart issues, etc.) all factor into what may or may not be the appropriate next step. With younger, newly diagnosed patients, a more aggressive approach to get to transplantation may be pursued. In older patients, the goal is usually to get to some level of remission, even if that isnt a permanent solution.

Some myeloma patients, however, dont respond to any of the available chemotherapy drugs or may have a cancer relapse after their transplant. Thats why there is excitement within the cancer community about clinical trials were participating in at the

Moffitt Malignant Hematology and Cellular Therapy Program at Memorial Hospital West that have increased what were able to accomplish through immunotherapy.

The new approach is called CAR-T cell therapy and its administered like a blood transfusion after the patients own T cells are reprogrammed to attack the cancer cells. This is done by genetically altering T cells so they produce synthetic molecules called chimeric antigen receptors, or CARs, which enable T cells to recognize and attach to a certain protein in tumor cells and kill them.

We see 70-80 new multiple myeloma cases each year and more than 300 with relapse disease so, while not every patient will be a CAR-T candidate, were hoping many more will be as the trial progresses. Were using drugs under research that are unavailable anywhere else in Florida for myeloma and expect to expand to include leukemia and lymphoma patients in the coming year.

All this work is being done as we establish a myeloma-specific institute at Moffitt/Memorial that will be the only one of its type in Broward and Palm Beach counties. Bringing specialists together and providing South Floridians access to clinical trials is part of what were planning, but its also important to address the whole person and not just the disease. Thats why were already collaborating with the Leukemia and Lymphoma Society of Broward County and have established a support group for myeloma patients and their caregivers. The group will address issues related to a cancer diagnosis and provide opportunities for attendees to discuss concerns, anxieties, feelings related to their illness, treatment, and connected issues. Meetings, even the virtual ones were having during COVID-19, are designed to offer mutual support and information to members by connecting them to others whose situations are similar to their own.

My own journey has taken me from my home country of Colombia to an internal medicine residency in Philadelphia, hematology/oncology fellowship in Memphis, and an advanced fellowship in hematologic malignancies at Dana Farber Cancer Institute in Boston. I was at Dana Farber for seven years before relocating to South Florida in 2017. I joined the Moffitt team at Memorial Hospital West in July and am anxious to further the research and treatment of multiple myeloma at one of the nations leading cancer centers. CAR-T cellular therapy is one of the ways we can get there together.

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New Weapons in the Battle Against Blood Cancers: Current Articles - South Florida Hospital News