ENBREL: A Possible New Treatment New treatments are being used to target newly recognized trigger factors for myeloma cell growth and abnormal protein production. One such target is TNF-alpha (tumor necrosis factor - alpha) which is involved in myeloma cell growth and the development of several side effects including anemia, bone disease and the deposition of abnormal myeloma light chains (Bence Jones proteins) as amyloid in the tissues. There is excess production of TNF-alpha in the bone marrow. Blocking TNF production can be helpful. It is likely that a major reason that thalidomide can be an effective treatment in myeloma is because it increases breakdown of TNF-alpha messenger RNA.
Another way to interfere with the effect of TNF-alpha is to bind it up with a soluble receptor. Etarnecept (ENBREL) is an agent which is under investigation to interfere with TNF in this fashion. A recent study from the Cleveland Clinic, reported at the ASH meeting, reported remarkable symptom relief in patients with advanced primary amyloidosis (patients with high levels of TNF-alpha and light chain production). ENBREL was given by subcutaneous injection twice per week and appears to have been quite well tolerated. It seems that this may be a promising new strategy with applications in other types of plasma cell disorders.