Amrita Krishnan, M.D., Director, Multiple Myeloma Program
City of Hope’s approach to treating myeloma starts with a coordinated, multidisciplinary care team, comprising myeloma specialists, whose main goals are controlling your disease so that you can live longer and maintain an active life.
Treatment for myeloma and multiple myeloma is rapidly advancing, and with the approval of new agents, survival rates for myeloma patients are on the rise. As a comprehensive cancer center, City of Hope is at the forefront of that progress. We were involved in pivotal early trials of two drugs — daratumumab and ixazomib — that are now part of myeloma therapy worldwide.
Each patient’s disease is distinct, so treatment plans at City of Hope are individualized and incorporate the newest combination therapies. For example, promising new immunotherapies are often combined with chemotherapy to increase the chances of effective treatment.
While we are experts in the entire spectrum of disease, City of Hope has extensive experience in treating patients who have high-risk or relapsed types of the disease and those who have undergone failed therapies.
All of our treatments are designed with quality of life in mind. We keep drug toxicity to a minimum so that you can continue to work and live normally, and we tailor therapy to include medications, called bisphosphonates, to deal with common disease-related bone problems. The goals of myeloma treatment at City of Hope include:
- Slowing down the disease progression
- Extending remission time
- Reducing symptoms
- Researching and developing curative therapies that may play a role in treatment
Types of Myeloma Therapy
- Single or combination drug therapy
- High-dose chemotherapy with bone marrow transplant
- Autologous: using a patient’s own stem cells
- Allogeneic: using donor stem cells
- Radiation therapy for local disease
- New and emerging therapies
- Supportive care
Bone Marrow and Stem Cell Transplantation
The most effective treatment for myeloma is high-dose chemotherapy combined with stem cell transplant, and City of Hope is a true innovator in this area — with one of the largest and most successful transplantation programs in the world.
We have set standards for stem cell transplantation and improving long-term outcomes. Using innovative approaches for blood and bone marrow transplantation to treat myeloma has led our Hematologic Malignancies Research Institute to be considered an industry leader with unrivaled survival rates.
To address the growing need for high quality transplantation, City of Hope recently expanded its bone marrow transplantation program to include outpatient procedures, allowing patients to return home after treatment. The program allows greater autonomy for multiple myeloma patients undergoing autologous (using their own cells) transplants and consistently receives high satisfaction ratings.
Chemotherapy, a common treatment for myeloma, uses drugs to either kill cancer cells or stop them from growing. This approach usually is necessary to kill cancer cells circulating throughout the body.
Exciting advances in chemotherapy at City of Hope are allowing patients with advanced disease to get drug combinations —including combining targeted therapies, radiotherapies and immunotherapies with chemotherapy — designed to slow down disease progression and improve quality of life.
Immunotherapy is a way of awakening the immune system to action against cancer cells. Immune cells patrol the body in search of disease, but cancer cells often devise ways to get around or suppress them. City of Hope is developing and testing drugs that can unleash dramatic and specific immune responses to cancer cells — or make them visible to the immune system.
City of Hope has virtually unrivaled expertise with immunotherapy — and was involved in pivotal early trials on drugs that are now a big part of myeloma therapy worldwide, including daratumumab. We are on the leading-edge of drug treatment for myeloma, and we have ongoing clinical trials aimed at identifying even more effective immunotherapy treatments, including exciting advances in CAR T cell therapy, check point inhibitors, bispecific antibodies and novel antibody-drug conjugates.
City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and use medications to stop them from growing. Knowing how a tumor behaves and how it would respond to different therapies allows us to created targeted therapies: drugs or drug combinations that would work best to treat specific cancers.
Radiation therapy uses high-energy radiation to kill plasma cells and shrink tumors. It is an effective treatment for myeloma and often is paired with other treatments. City of Hope offers advanced radiation treatments that are highly targeted to cancer cells while protecting the surrounding normal tissue.
One technique, TomoTherapy, includes delivering focused radiation to the entire bone marrow compartment. The technique, called total marrow irradiation, is an effective way to target cancer cells while reducing side effects.