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Myeloma Center physicians Sharmilan Thanendrarajan, M.D., Ph.D., Samer Al Hadidi, , M.D., clinical director Frits van Rhee, M.D., Ph.D., Carolina Schinke, M.D., and Maurizio Zangari, M.D. Image by Bryan Clifton

Looking Toward the Future: Myeloma Center Celebrates 35th Anniversary

April 7, 2025 | The Myeloma Center, located in the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences (UAMS), has firmly established itself as an international leader in myeloma treatment. From its beginnings in 1989, UAMS’ myeloma program is recognized for detailed patient care, groundbreaking research and pioneering advances in the management of myeloma and its related conditions.

From the Total Therapy approach, the introduction of tandem autologous transplants, the creation of a prediction model for stem cell collection and the current implementation of innovative immunotherapies, the path towards a cure for myeloma continues — with UAMS leading the way.

Myeloma Center Clinical Director Frits van Rhee, M.D., Ph.D., and his team embrace the task of developing new methods of treating this disease.

“Patients and providers worldwide know the UAMS Myeloma Center and the Winthrop P. Rockefeller Cancer Institute as the best option to receive care for this condition,” said Cam Patterson, M.D., MBA, UAMS chancellor and CEO of UAMS Health. “The standard of excellence by this dedicated group of health care professionals is unmatched, and we look forward to a brighter future in the course of myeloma research and treatment.”

The Process

The exact cause of myeloma is unknown, which presents unique challenges for physicians and researchers. Many of the symptoms are common to other conditions, and symptoms may not present themselves in the disease’s early stages. Total Therapy, pioneered at UAMS, was a revolution in myeloma treatment.

“This approach uses induction chemotherapy to bring the disease under control,” van Rhee said. “Autologous stem cell transplants are followed by consolidation treatment to further reduce the cancer. Maintenance therapy is used to prevent relapse.”

Patients typically receive three drugs (dexamethasone, Revlimid and Velcade) for three years. Approximately 30% of patients who have a standard risk of myeloma will not relapse. The anti-CD38 monoclonal Darzalex was introduced, which further enhanced the efficiency of this approach.

Van Rhee notes two main challenges in treating myeloma.

“Not all patients are fit enough to receive such a comprehensive treatment approach. Also, the cure rate of more aggressive myeloma is much lower.”

The need for more effective and less toxic therapy led the Myeloma Center into the next stages of myeloma treatment.

Bispecific Antibodies

The advent of bispecific antibodies plays a crucial role in myeloma treatment, particularly for those patients with relapsed refractory myeloma. Bispecific antibodies are constructed to bind to both myeloma cells and immune cells, which activates T-cells to destroy cancer cells.

“Bispecific antibodies have been a game-changer,” said Myeloma Center physician and researcher Carolina Schinke, M.D. “They’re very effective. They have toxicities, but we’re learning how to treat them.”

The following treatments have been approved by the Food and Drug Administration (FDA) for use with myeloma patients:

• Elranatamab
• Talquetamab
• Teclistamab

“Clinical trials for bispecific antibodies are ongoing for treatment in the earlier stages of myeloma,” van Rhee said. “One trial is with the bispecific antibodies talquetamab and teclistamab as a front-line treatment for high-risk myeloma.”

An important benefit of antibody therapy is it is immediately available for injection and does not require chemotherapy. Bispecific antibodies may also be a preferred option for patients who cannot tolerate standard chemotherapy.

“We hope that this innovative therapeutic approach will improve outcomes for high-risk patients,” said van Rhee.

CAR T-cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary option for patients who have had several lines of treatment. Already in use with other forms of cancer, in 2021 the Myeloma Center performed this procedure on a myeloma patient for the first time in Arkansas. UAMS is the only medical facility in the state where this therapy is available for those diagnosed with myeloma.

“CAR T-cell therapy has greatly improved the treatment of patients with relapsed myeloma,” said van Rhee.

CAR T-cell is B-cell Maturation Antigen (BCMA) targeted therapy, in which the patient’s T-lymphocytes immune cells are collected and manufactured to recognize the BCMA protein on the surface of myeloma cells. After infusion, the manufactured CAR T-cells activate and destroy myeloma cells.

“One advantage of CAR T-cell therapy is that it’s a very personalized approach,” said Syed Naqvi, M.D., a Myeloma Center hospitalist who performs this procedure. “By using the patient’s own cells, they can be engineered to fight the disease specifically in that patient.”

The FDA approved ide-cell (idecabtagene vicleucel, ABECMA) in March 2021 as the first CAR T-cell product for myeloma patients who had received at least four different treatments. Clita-cel (ciltacabtagene autoleucel, CARVYKTI) received FDA approval in February 2022 for patients with minimal or no response to previous treatments, or for those who have relapsed after four lines of therapy.

In April 2024, the FDA approved the use of these therapies earlier in the treatment process. Ide-cell may now be administered to patients with relapsed refractory myeloma who have had at least two prior lines of treatment. Clita-cel is now available for those who have received at least one prior line of therapy.

“We have treated almost 100 patients with CAR T-cells and are very excited about the results,” van Rhee said.

“The future of CAR T-cell therapy is very promising,” Naqvi said. “If we’re able to treat patients earlier, those patients may have healthier cells, and we may be able to achieve better results as opposed to patients who have had multiple lines of treatment.”

Patient Care

Patient care is the top priority for the Myeloma Center team.

The complete array of services available dramatically shortens the time patients are required to be at UAMS for appointments. Blood work, MRIs and positron emission tomography (PET) scans are all offered on-site, with results promptly available for review by the patient and physician.

“We have a tremendous advantage here because the patient doesn’t have to go anywhere else for tests,” said van Rhee.

This is especially important for the many out-of-state patients who receive treatment at the Myeloma Center. A patient can complete all requested tests one day, then visit with their physician and leave the following day.

The advent of novel therapies allows the Myeloma Center to further its goal of personalized treatment for each patient, based on factors such as age, overall health, laboratory and imaging results, and any prior treatment.

“Not all methods work for all patients,” van Rhee said. “Tailoring the plan for each person allows us to specifically target the myeloma and provide the best chance of cure with minimal side effects.”

Going Forward

The next phase of myeloma care includes further movement away from traditional chemotherapy and more use of immunotherapies, van Rhee said.

“An important question is whether CAR T-cell therapy can replace autologous stem cell transplants,” he said. “The Myeloma Center is participating in a large international trial where patients are being randomly allocated to either CAR T-cell therapy or stem cell transplants in hopes of answering this question.”

Immunomodulatory drugs such as Revlimid and thalidomide modify or regulate the immune system. Proteasome inhibitors, which include Ninlaro and Velcade, target enzymes that remove waste proteins from cells and keep them healthy. Monoclonal antibodies such as Darzalex target specific proteins on myeloma cells.

The Myeloma Center is authorized to perform CAR T-cell therapy as an outpatient procedure, which is another benefit for patients who are healthy enough to recover at home.

Still, there are significant questions remaining to be answered regarding the future of myeloma treatment, van Rhee said.

“Both CAR T-cell therapy and bispecific antibodies have unique side effects. Individual patient selection for the most appropriate therapy is important. It is also crucial to understand why some patients relapse after these therapies.

“Novel approaches and new drugs are being developed, which will hopefully still further improve outcomes,” he continued. “One class of drugs are referred to cereblon E3 ligase modulators (CELMoDs), which are more effective versions of the immunomodulatory drugs lenalidomide and pomalidomide. New generations of CAR T-cells and bispecific antibodies are also being developed.”

“A lot of research is happening to determine how to best combine all of these new treatment options,” van Rhee said. “Overall, these are very exciting times, and we hope to make even more progress in the coming years.”

Myeloma Center Facts and Firsts

1989 – Introduced tandem transplant approach

1991 – First outpatient stem cell transplant

1997 – Introduced the first novel drug for myeloma (thalidomide)

1998 – First to utilize PET scan for diagnosis and assessment of treatment response

2006 – Identified seven molecular genetic subtypes of myeloma and their bearing on prognosis

2007 – First to use gene expression profiling for risk stratification and assignment to therapy

2014 – 10+ year follow-up indicates that cure is achievable for patients with low-risk myeloma

2018 – First book on Castleman disease published

2021 – Performed Arkansas’ first chimeric antigen receptor (CAR) T-cell therapy treatment for myeloma

2023 – Published 1,000^th research paper