June 10, 2011 | A clinical trial on a first-of-its-kind treatment for multiple myeloma is now under way at the UAMS Myeloma Institute for Research and Therapy, using supercharged immune cells known as natural killer cells to attack cancer cells.

Led by Bijay Nair, M.D., assistant professor of medicine in the UAMS College of Medicine, the trial is now recruiting patients with the most aggressive form of multiple myeloma, a cancer of the blood’s plasma, who have relapsed. The trial builds on a small-scale trial at the Myeloma Institute in 2006 – as well as laboratory research on myeloma cells – that showed the natural killers could recognize and kill tumor cells.

The two-and-a-half year trial is expected to include 30 patients who will be treated with injections of the natural killer cells harvested from either a family member donor or the patient.

“This is an entirely different approach to treating multiple myeloma, which until now has been treated mainly by chemotherapy,” Nair said. “This therapy does use some chemotherapy but the focus is on use of natural killer cells.”

Natural killer cells are immune cells that exist in the blood and are primarily defenses against virally infected cells.

In this clinical trial, the natural killer cells will preferably come from a parent, child or sibling who matches the patient. Nair said in the previous trial the cells from a family donor proved effective against cancer cells – although a patient’s own cells can be used if there is no family donor.

The harvested cells will be sent to a lab in Texas where they will undergo a process that prompts them to multiply exponentially and also become more effective cancer cell killers. The so-called expanded and activated cells will then be sent back for injection into the patient.

“Expanding the cells will increase the effectiveness and will kill more cancer cells,” Nair said. “We saw up to 80 percent cell kill with expanded cells against multiple myeloma cell lines in lab tests.”

Natural killer cells in the earlier trial were not expanded, he said. The natural killer cells persist in the body for about a month following injection.

The trial will involve patients with the most aggressive form of the disease. It was researchers at the Myeloma Institute who found that genetic patterns could predict which forms of the disease are less aggressive, or low-risk, and more aggressive, or high-risk. About 15 percent of patients have high-risk myeloma.

For patients identified with high-risk myeloma who have relapsed, there are not a lot of treatment options, Nair said.

“This is the patient population most in need of a novel approach,” he said. “If this treatment succeeds here, most likely it will work with other types of myeloma.”

Until now, treatment of myeloma has focused on chemotherapy. “The key is developing a treatment that is less toxic to the body than chemotherapy,” Nair said.

The chemotherapy used in this trial is intended to suppress the patient’s immune system, paving the way for the injection of the natural killer cells, he said. Nair said he anticipates a higher likelihood of response to the therapy with the immune system suppressed.

An injection of a molecule known as interleukin 2 also will be given to patients to help the natural killer cells survive longer in the body following infusion, he said.

The Myeloma Institute is the only center in the world devoted exclusively to research and clinical care related to multiple myeloma and related disorders. Founded by Bart Barlogie, M.D., Ph.D., the UAMS multiple myeloma program has seen more than 9,000 patients from every state in the United States and more than 50 foreign countries.