Multiple Myeloma: ‘Total Therapy’ Promotes Recovery

Fall 2013

Dr. Bart Barlogie

In the past 25 years, the UAMS Myeloma Institute for Research and Therapy established itself as the world’s foremost treatment center for multiple myeloma, a particularly nasty cancer of the bone marrow.

A potent combination of technology, teamwork and a culture of moving fast has served the institute well and positioned it for the future.

Many of the 39 surviving patients who were part of the institute’s first major clinical trial for treating multiple myeloma, which started in November 1989, still return for care. The institute has had a relentless dedication to cure multiple myeloma since Bart Barlogie, M.D., Ph.D., arrived at UAMS that same year, a time when the median survival for myeloma patients was only 30 months.

Today’s median survival figures for patients treated at the Myeloma Institute exceed 10 years.

The institute uses the newest genetic analysis tools to guide treatment plans determined by the genetics of myeloma in each patient. This puts the Myeloma Institute on the vanguard of personalized medicine.

“I think historically we have taken rather bold approaches and patients have trusted our judgment,” said Bart Barlogie, M.D., Ph.D., the Myeloma Institute’s founding director. “We are unique because our patients are being cared for here from diagnosis on. They don’t come here just for consultation but for active, continuous management.”

Multiple myeloma, the second most common blood cancer, weakens the body’s immune system and often causes bone destruction, leading to pain and broken bones.

The Myeloma Institute developed a “total therapy” concept — applying all elements of treatment, including high-dose chemotherapy and eventually transplants of blood stem cells that promote recovery all together. Advances in imaging technology and genetic analysis allowed the institute to identify how different tumor genetics can be used to predict patient outcome.

Those discoveries led to a method for identifying patients who would be more responsive to treatment (low-risk) or less responsive (high-risk) based on the genetic makeup of their disease. It allowed use of the word “cure” for the first time — a word Barlogie insists is appropriate.

Bart Barlogie, M.D., Ph.D.“We now predict that half of the patients diagnosed with the low-risk, less aggressive form of the disease — which makes up 85 percent of newly diagnosed cases — can be cured,” Barlogie said. “In the low-risk disease, we have finally published — and it was very difficult — we actually had the ‘cure’ word in the title of a journal article in 2012.”

More than 90 percent of patients are actively followed over the course of their lifetime. The close follow-up of patients has allowed early detection of relapse and helped the institute amass an enormous amount of data on the disease that has led to a better understanding of the disease’s behavior and treatment response.

That data and the growing biorepository, includes more than 100,000 cell samples, some 10,000 genetic samples, 50,000 MRI scans and 25,000 PET scans. The clinical data and biorepository represent an unmatched resource for future research, Barlogie said.

Now the Myeloma Institute seeks better treatments for high-risk patients while working toward less arduous and less expensive — but no less effective — treatment plans for those with low-risk myeloma.

Barlogie dismissed those who talk merely of controlling multiple myeloma like diabetes. “I want to cure everybody with myeloma.”