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Understanding the Body's Immune Defenses Against Myeloma

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A recent article in the New York Times draws attention to how cancers survive and evade the immune system and highlights a new book, "The Compatibility Gene: How Our Bodies Fight Disease."  The key point for myeloma research is that inactivation of T-lymphocyte cells and natural killer cells--which should be killing myeloma cells--occurs through a mechanism called the PD-1/PD-L1 system.

The way it works is that the myeloma cells and many other types of tumor cells have many PD-L1 receptors on their surfaces. These receptors work as a protective shield because the PD-L1 triggers the surrounding immune cells to stop working - allowing, for example, myeloma cells to grow. Research in other cancers is much further along, and novel anti-PD antibodies have been developed which block this process and allow the immune cells to attack those cancers.  There has been great success with this in patients with melanoma, some of whom have had dramatic remissions.

What about myeloma? The research is not as far along, but one anti-PD1 antibody (CT-011) has been used in early testing and shows benefit.

This is exciting because it provides an entirely new approach to attack myeloma.  Dr. David Avigan and the research team at Beth Israel Deaconess Medical Center in Boston are exploring the use of the CT-011 anti-PD antibody therapy as part of a vaccine approach to myeloma therapy. Early results are promising.

So, a better understanding of what can be wrong with the immune system in myeloma patients is leading to ideas about how best to fix the problem! Stay tuned. I am sure further progress will be reported and next steps developed to improve responses and outcomes for myeloma.  

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF Hotline staff instead. Questions are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate. To contact the IMF Hotline, call  800-452-CURE, toll-free in the US and Canada, or send an email to hotline@myeloma.org. Hotline hours are 9 am to 4 pm PST. Friday summer hours are 9 am to 3 pm PDT. Thank  you.

13 Comments

my friend was diagnosed with MM 2 years ago and has a sister that was diagnosed with MM about 10 years ago.

My friend has lost most of her vision due to increased blood pressure either from the disease or the drugs.

She would like to speak with others who have had visual problems as this seems to be a rare side effect.

The visual loss is her most debilitating symptom to date.

thank you,
Rena

I am trying to reach Ingrid, who commented on 12/31/13 to my post of 10/31/13.

Thanks,
Rena

I was diagnosed with smoldering MM about 10 years ago. Main symptom was vision problems. The protiens are mebedded in my corneas making my vision very cloudy. Very very rare. Went to Duke,NC and Boston Eye and Ear Treament Center. Would be happy to talk with you.
Ingrid

There seem to be so much anecdotal evidence pointing to environmental agents as possible triggers for the onset of myeloma. I don't recall any extreme exposure to chemicals prior to my diagnosis in 2010. But I do recall being under incredible stress. Perhaps both stressors in tandem lead to an increased susceptibility to developing myeloma as well as other cancers. There was an article this past week (Oct.20-26, 2013) that described the increased incidence of cancer to those exposed to the air after 9/11 near ground zero. I visited the area two months after the tragedy and remember how much debris there was in the air. Almost like a fog. Could this have triggered my myeloma, in conjunction with stress?

I was diagnosed with MM several years after using two very "smelly" chemicals. One was an herbicide and the other was a stain called "Rymar" which we used on our redwood house. I remember that I used very little protection and that the smell was so bad it almost made me sick to my stomach. No one has ever surveyed me for possible connections to chemicals such as the ones I used.

My own experience with immunotherapy for myeloma has been very positive. I did an allo in Spring 2011 and have been in a sustained molecular response ever since. My quality of life is excellent. I have no extensive chronic GVHD and I only need to go for Zometa every 3 months. Last month I spent no time at any medical provider, this month I only needed a flu shoot. That is great considering I was diagnosed as a high risk patient in Fall of 2010. It will be a great day when older patients not eligible for allo transplant have a form of immunotherapy that works as well as allo transplant did for me and they have chance for a better QOL than they can have on "never ending cycles" of drugs.

Mark, I am also a high risk mm patient 4;14 I was in a clinical trial over 4 years ago mainly useing velcade. I was in complete remission for 4 years and have since gone out of remission. My protein numbers are staying low but will need treatment in the future am I am interested in the fact that you had a transplant as with 4;14 results are supposed to be reduced. If you could provide any helpful information on your experience it would be apprciated.

Mark,

I was diagnosed with high risk mm February 2012. I would like to talk to you about your allo as I chose to do auto due to the high risks associated with allo.

Thanx,
Paul
Pgeilingvt@yahoo.com

Paul,

I too have had a recent transplant and would love to discuss with you. It seems to help in giving information and questions back-and-forth. If interested please feel free to call me at 720–2 60–9344 in Denver.

Best,

Jean

This great news! I am recently diagnosed in June 2013. Would love to see a cure!

Thanks for the update. Having dealt with IGA Multiple Myeloma for 5 years now with a stem cell transplant and relapses I pray for breakthroughs. Awareness is so important and sometimes we get lost in the shuffle with all the awareness of other cancers.

This blog on Anti PD antibodies in Myeloma treatment is interesting. However we normally don't care about damaging our innate and adaptive immunity from the so called new gadgets we all use in our homes and other places viz Microwave Ovens and the present day monster in developing countries called Induction Cookers. I presonally believe that Microwave Oven was the cilprit to blame as the reason for Myeloma inducton in a 45 year old Indian born Brtish in a small Indian Restaurant in Leicester, England in 1981(this was my first observation and again the knowledge about the First Microwave Oven introduced to me by the same restaurant owner in 1977, the machine operating just behind him from morning to night hours. In less than 4 years hedeveloped Myeloma) and the latest observation in 2006 in a relatively young British lady who was working amidst 15 Microwave Ovens surrounding her work place in a food processing firm. My repeated requests for including such a questioare in Myeloma trial proformas were also not considered, possibly because of my post-retirement fixed term consultant position in that hospital in 2006. However I am still propagating this concern among my patients, friends and family members so that they may at least be aware of the health risks of these modern gadgets people consider as ornamental to their kitchen.

I am an 83 yr old man being treated for MM for 21/2 yrs and wonder if this new approach could be used on an elderly patient. I recently had my treatment tweeted because my numbers were not stable as they had been for a spell.

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