Stem cells help in the treatment of multiple myeloma

Researchers from the University of Pennsylvania School of Medicine, USA managed to achieve sustained remission in a patient with multiple myeloma using personalized stem cell therapies. The results were published September 10, 2015 in the journal New England Journal of Medicine.

In patient with multiple myeloma (MM), is no longer responding to chemotherapy after nine different methods of treatment, there was complete remission after undergoing personalized cell therapy, known as CTL019, developed by a team of University of Pennsylvania.

This treatment combines chemotherapy with autologous stem cell transplantation, and is a new strategy aimed at finding and destroying cells that regenerate in myeloma cells.
Before the passage of therapy CTL019, the patient has already received nine different types of treatment for five years after the diagnosis of MM, including autologous stem cell transplantation. However, transplantation has helped control the disease for only a few months.

The bone marrow of the patient was almost completely filled with cancer cells, when she agreed to the experimental treatment. Within 130 days after the injection of the created experimental reprogrammed cells, tests found no signs of the disease. The patient remains in remission for more than 12 months after undergoing therapy.

For the treatment procedure CTL019 first patient’s own cells obtained by the procedure similar to dialysis. The cells are then “programmed” to detect and destroy cancerous cells in the patient.
Patients participating in the trial were diagnosed with acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL) or non-Hodgkin’s lymphoma (NHL). All of them have passed lymphodepleting chemotherapy before the introduction of autologous reprogrammed cells.

Modified T-cells express the chimeric antigen receptor (CAR), specific to cells bearing on the surface the protein CD19. This protein located on the surface of B cells, including cancer, which characterize some types of leukemia and lymphoma.

Scientists from the University of Pennsylvania have developed a different approach for the treatment of multiple myeloma. Along with autologous stem cell transplantation, the patient was injected the drug of lymphodepleting chemotherapy melphalan, and two weeks later were injected with the drug CTL019.

Despite the fact that myeloma, as well as leukemia and lymphoma, flows involving white blood cells – lymphocytes, myeloma cells usually do not express CD19, since they originate from the most mature forms of lymphocytes – plasmocytes.

“We were a little skeptical about the positive results of treatment of this disease, directed on CD19, as in this case, almost all cancer cells in the plasma do not express the CD-19”, – said study lead author Dr. Edward Stadtmauer. “Ever since it was reported that stem cells can be CD19-positive, we have assumed that it is possible to create a therapy based on the impact of the early precursors of these cells.”

The patient participating in the study after transplantation and prior to the introduction CTL019, observed side effects: neutropenia, thrombocytopenia, nausea, fever, and various infections. After injection of modified cells she had no fever or other symptoms of cytokine release syndrome observed in other patients receiving therapy CTL019.