Nov. 13, 2009 | Prospects for many patients diagnosed with multiple myeloma, a cancer of plasma cells, have changed dramatically since the Myeloma Institute for Research and Therapy (MIRT) was established in 1989 at the University of Arkansas for Medical Sciences (UAMS).

As the institute celebrates 20 years of progress, founder and director, Bart Barlogie, M.D., Ph.D., talks in terms of successful treatment for many patients. Based on years of research by Myeloma Institute scientists, clinical trials under way target high-risk and low-risk disease as defined by genetic profiling.

“We now predict that half of those 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. “While those with the more aggressive or high-risk form of multiple myeloma face more of a challenge, we will not stop until we can say the same for all of our patients.”

In multiple myeloma, plasma cells (white blood cells that form in the bone marrow and that produce disease- and infection-fighting antibodies) multiply abnormally and interfere with normal production and function of red and other white blood cells. The abnormal plasma cells, known as myeloma cells, also prevent the normal production of antibodies, leaving the body’s immune system weakened. Myeloma cells commonly produce substances that cause bone destruction, leading to bone pain and/or fractures.

During the past 20 years the institute has treated more than 9,000 patients who have come to UAMS from every state and more than 50 foreign countries. The institute treats more multiple myeloma patients annually than any other facility in the country.

Among the milestones achieved in the institute’s history:

• Five-year survival rates at the Myeloma Institute are greater than 65 percent. The median survival for Myeloma Institute patients is 8.5 years.
• More than 8,000 blood stem cell transplants for treatment of multiple myeloma – a procedure pioneered at the Myeloma Institute and credited with leading to higher survival and remission rates
• Twenty-one percent of the 231 patients enrolled in UAMS’ initial multiple myeloma clinical trial known as Total Therapy 1 are still alive beyond 10 years, with some alive at 19 years
• Of almost 480 patients enrolled in a subsequent Total Therapy clinical trial initiated in 2003, 78 percent are alive
• Myeloma Institute researchers have identified different genetic types of the disease and have studied its cellular triggers in order to find out why some treatments work better than others for certain patients
• The Myeloma Institute recently achieved accreditation for its stem cell procedures (collection and transplantation) by the Foundation for the Accreditation of Cellular Therapy (FACT), the national group that monitors cellular therapy
• The National Cancer Institute recently awarded a five-year, $19.5 million grant renewal to Barlogie and the Myeloma Institute to continue its research, marking the fourth, five-year renewal of continuous funding from the NCI.

In addition, the Myeloma Institute was the first to:

• Use tandem bone marrow/peripheral blood stem cell transplants in its treatment protocol
• Perform transplants on an outpatient basis
• Safely transplant patients age 70 and above
• Transplant patients with renal disease
• Introduce thalidomide as anti-angiogenesis therapy

Barlogie credited the determination of clinicians and translational researchers “who dedicated their professional mission to curing myeloma” for the institute’s success. Added to that, he said, is an infrastructure of outstanding nurses and support staff “that has created a coordinated network of care that gives confidence and optimism to all of our patients.” He noted with pride that many nurses and other Myeloma Institute staff members have remained since the program’s inception.

The FACT accreditation, announced in October, confirms that the myeloma program follows standards agreed upon by leading experts in the field of cellular therapy and transplantation, said Elias Anaissie, M.D., a professor of medicine in the UAMS College of Medicine and director of supportive care at the Myeloma Institute. The FACT accreditation is from the International Society for Cellular Therapy and the American Society for Blood and Marrow Transplantation.

The accreditation covers adult autologous hematopoietic progenitor cell transplantation, peripheral blood cellular therapy product collection and cellular therapy product processing. Anaissie said the accreditation is looked at by both referring physicians and insurance companies.

“We believe FACT Accreditation will reinforce that our facility strives to achieve the highest quality care for cellular therapy treatment programs,” Anaissie said.

Barlogie pointed to a continued move toward personalized medicine in multiple myeloma treatment. In the ongoing clinical trials, the treatment plans are based on gene array results that are available within 96 hours of a new patient’s arrival at the Myeloma Institute.

MIRT is the only facility in the world that routinely offers gene array analysis for newly referred patients and utilizes this information for patient management and planning of therapy.