This week’s “Ask Dr. Durie” comes from
a patient who has an inquiring mind and wants to know, “if myeloma is caused by genetic
mutations, how can this be changed to achieve cure?” And so, obviously this is an interesting and
excellent question and so one has to consider a few aspects to answer this fully. So the first thing is that the genetic mutations,
the DNA damage, which is linked to the myeloma, is just of the myeloma cells. This damage is targeting those cells and is
not damaging the rest
of the cells in the body. And so, one can focus one’s energies and
attempts at treatment at the myeloma cells themselves. However, there is another aspect which may
have been in the questioner’s mind, and that is there are genetic changes. Every individual is a little bit different
and so one’s genetic makeup can affect the predisposition to myeloma. So, some people are perhaps a little bit more
susceptible to myeloma versus another and this is the underlying background to the disease. And obvi
ously, this is something that one
cannot change. And so, as far as the genetic mutations of
the myeloma, the way that we approach this with treatment currently is in two ways. Number one, we use overall myeloma therapy
to target and to destroy the myeloma, no matter what mutations are contained within the cells. And so, we are eliminating those myeloma cells
with the mutations, we’re not in any way attempting to change them. The second thing that we are doing with great
success now is using immu
ne therapies of different types. For example, T-cell therapy, such as CAR T-cells,
which are engineered T-cells which are given back to the patient and can target and wipe
out the myeloma. This is particularly interesting and helpful
because it can destroy myeloma cells, no matter the mutations within the cell because it’s
targeting antigens which are expressed on the surface of the cell, such as CD38 or BCME,
another one to target for CAR T-cells. And so, there is an important aspect to the
gen
etic mutations, which it is that it’s restricted to the myeloma cells and the other
normal myeloma cells, the other cells in the bone marrow of a myeloma patient and the rest
of the body cells are not affected by that mutation. And so, bottom line, the mutation is one that
we can target directly with our anti-myeloma therapies, whether it be a direct approach,
or using the new immune approaches.
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