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Myeloma Center clinical director Frits van Rhee, M.D., Ph.D.
Q&A with the Myeloma Center Clinical Director
| Myeloma Center clinical director Frits van Rhee, M.D., Ph.D., answers questions about multiple myeloma and its treatment at the University of Arkansas for Medical Sciences (UAMS) Winthrop P. Rockefeller Cancer Institute.
Van Rhee also is a professor in the UAMS College of Medicine, the associate director of Clinical Science at the Cancer Institute and holds the Charles and Clydene Scharlau Chair for Hematological Malignancies Research. He oversees the Clinical Trials program at the Cancer Institute and has published extensively about the immunotherapy of myeloma and other blood cancers.
He earned his medical degree from Erasmus University, Rotterdam, Netherlands, and his Ph.D. at the Imperial College of Science, Medicine and Technology, University of London. He was a Fogarty Fellow at the National Institutes of Health.
Is family history a factor in whether someone will develop multiple myeloma?
In general terms myeloma is not an inherited disease. However, having a first‑degree relative (parent, sibling, or child) with multiple myeloma or its precursor MGUS (monoclonal gammopathy of undetermined significance) increases your risk modestly. The increased risk is generally two to four times higher than average, according to large epidemiological studies. It is important to bear in mind that myeloma is a rare disease and that the absolute risk of developing myeloma for a first-degree relative is still very low.
How has chimeric antigen receptor (CAR) T-cell therapy changed multiple myeloma treatment?
CAR T-cell therapy is a revolutionary new treatment that is presently approved for patients who have relapsed. It is no longer a treatment of last resort but is now an option for early or even first relapse. A very large international study (CARTITUDE-6) is ongoing in which standard autologous stem cell transplant is compared to CAR T-cell therapy for the treatment of newly diagnosed myeloma. It may well be that CAR T-cell therapy will replace autologous stem cell transplant in the future.
Does UAMS still use traditional chemotherapy for multiple myeloma?
The current approach to treating myeloma comprises induction, autologous stem cell transplant (if the patient is transplant eligible), consolidation and maintenance. This approach has been developed at the Myeloma Center. The core drugs for induction and consolidation are bortezomib (Velcade), lenalidomide (Revlimid), dexamethasone and the antibody daratumumab (Darzalex). Autologous stem cell transplantation has been performed since the 1980s, with the Myeloma Center performing the first autologous stem cell transplant in the outpatient setting in 1991. Standard maintenance is with lenalidomide and daratumumab. Treatment intensity is tailored to the aggressiveness of the disease and the fitness of the patient. We do often use some older drugs for one cycle since this greatly facilitates stem cell collection.
Why should someone come to UAMS for multiple myeloma?
Our goal is to offer a personalized approach for each patient. The patient’s journey starts at our Intake Office, where our excellent staff helps the patient to become established at the Myeloma Center and facilitates their first evaluation. An individual treatment plan is developed at the initial doctor’s visit. Our nurses, nurse practitioners and physicians aim to offer excellent, low-threshold care to achieve the best outcome for each patient. Our long-term follow-up data demonstrates that myeloma is a curable disease with currently available therapies. We also collaborate closely with the patients referring local oncologists.
What do you see in the future for multiple myeloma treatment?
The new immunotherapies, CAR T cells and the bispecific antibodies will usher in a new era of myeloma therapy and further improve outcomes. We are starting a groundbreaking clinical trial for high-risk patients with newly diagnosed myeloma using two bispecific antibodies that will be given in an alternating fashion and which attack different targets on myeloma cells. Patients who achieve deep remission will not receive stem cell transplant. In the future, the new immunotherapies will be incorporated in frontline therapy and totally change our approach to treating myeloma. We also expect many new exciting treatment approaches to emerge.