Researchers believe combining elotuzumab and PBMC treatments with ASCT and lenalidomide maintenance may be an effective treatment option for multiple myeloma.
Multiple myeloma (MM) is a hematological cancer of bone marrow plasma cells. In MM, the antibody-producing plasma cells transform into malignant myeloma cells that produce abnormal antibodies (M proteins). When M proteins accumulate, they outnumber and overcrowd the normal antibodies. Patients with MM can experience bone and kidney damage, anemia, and an impaired immune system.
Elotuzumab is a humanized monoclonal antibody against SLAMF7 (expressed on myeloma cells and induces natural killer (NK) cell activation), is an FDA-approved drug for the treatment of patients with relapsed MM, and is given in combination with lenalidomide and dexamethasone. Given the role of NK cell activation in the antitumor effects, scientists conducted studies to determine the safety of combining elotuzumab treatment and autologous peripheral blood mononuclear cell (PBMC) infusion (to provide NK cells post-transplant) to autologous hematopoietic stem cell transplantation (ASCT) and lenalidomide maintenance.
The researchers believe that this approach may promote anti-MM immunity and provide a means to extend progression-free or minimal disease state. Leukopheresis for PBMC collection was performed for patients with MM, and peripheral blood stem cells were harvested. After standard conditioning with melphalan, autologous PBMCs were reinfused into the patients. They then received cycles of elotuzumab treatment and lenalidomide maintenance. Safety of the treatment strategy was assessed, as well as progression free survival after one year of treatment.
Of fifteen patients in the study, only one experienced neutropenic fever during the autologous hematopoietic stem cell transplantation. The majority of the adverse events observed were grade 2 or below. Delayed hematopoietic reconstitution resulting in more than 21 days of hospitalization was observed in one patient. There was a one-year progression-free state after one year of treatment in 93% of the patients (14 out of 15). The results suggest that the addition of elotuzumab and PBMC infusion with standard ASCT and lenalidomide maintenance for MM consolidation therapy is safe and practical. Additional studies are planned to better determine efficacy.
Elotuzumab plus stem cell transplant shows promise for multiple myeloma . (2018). Healio.com. Retrieved 27 March 2018, from https://www.healio.com/hematology-oncology/myeloma/news/online/%7B7feae0e9-2c3f-4873-b07d-f005c1560c7a%7D/elotuzumab-plus-stem-cell-transplant-shows-promise-for-multiple-myeloma