I remember taking an upper division immunology class in college. For the course, we were given a Salmonella culture and a live rabbit. Our goal was to create a vaccine from the Salmonella culture and immunize the rabbit against the bacterium. I was assigned Salmonella newington which historically had caused outbreaks of infections in hospitals and in poultry farms. This particular Salmonella subspecies was named after an outbreak in Newington, Connecticut. My rabbit survived and was taken to the farm where he lived out his life…fully immunized against Salmonella newington. Other than the dreaded childhood immunizations, this was my first experience with antibodies and the immune system.
During my first year of medical school, I met Dr. Thomas Starzl, the grandfather of liver transplantation, and one of the lecturers of my anatomy class. Dr. Starzl began transplanting livers in the early 1960s. His first successful transplant was in 1967 at the University of Colorado when effective immunosuppressive drugs were developed to prevent rejection of the donor liver. This was one of my first experiences with immunosuppressive drugs. In this case, the drugs manipulate the immune system allowing a foreign liver to maintain life.
I received my stem cell transplant in 2011 at Cedars Sinai Hospital in Los Angeles. The same hospital that I had previously sent some of my patients for liver transplantation. They were treated with donor livers, given immunosuppression and would go on to lead successful lives. They raised families, saw their children graduate from high school and attend weddings. At that time, I had no idea then that I would develop a cancer of the immune system. It originated from a disordered plasma cell that was able to overcome my own body’s defenses. I would be treated by an excellent staff at the same institution. I also was given immunomodulators after stem cell transplantation that have allowed me to survive and to walk my own daughter down the aisle at her wedding.
As an attendee of ASH 2017 in Atlanta, I am excited to learn of the new developments in treating multiple myeloma. The concept of a living therapy using one’s own T cells that have been genetically engineered is remarkable. These T cells are able to attach to specific proteins on cancerous cells that have previously eluded the body’s natural defenses. Chimeric Antigen Receptor T cells (CAR-T cells) can survive and multiply in the body to continue to suppress tumor growth as it appears. CAR-T cells have been successfully used in other blood cancers such as acute lymphoblastic leukemia in children and lymphomas and now multiple myeloma. These developments are the result of many years of research by dedicated scientists and clinicians that will be sharing their results at ASH.
Of course, there are the new drug therapies. Monoclonal antibodies and combinations of these drugs with immunomodulators, proteasome inhibitors, and steroids also show promising results. I am interested to learn how minimal residual disease (MRD) is now being used in clinical practice with these new treatments. Finally, I am interested in remission, relapse rates and penta-refractory disease as they apply to these new drugs and therapies.
As a myeloma patient, I am grateful that the International Myeloma Foundation (IMF) has given me the opportunity to witness first-hand the latest research presented by the world’s experts on this disease.