Novel Treatment Strategies and Stem Cell Transplantation - Episode 3
Rafat Abonour, MD: My name is Rafat Abonour. I’m a hematologist at IU [Indiana University] Health, and my role is to direct the multiple myeloma, Waldenström macroglobulinemia, and primary amyloidosis programs.
IU Health has a very long tradition of providing novel therapy to patients with advanced cancer—solid tumors and hematologic malignancies.
Relapsed Germ Cell Tumors
IU Health has expertise in treating relapsed germ cell tumors. We’ve been able to cure a large number of newly diagnosed germ cell tumors with a regimen that was conceived here by Lawrence Einhorn, MD. But for the relapsed patients, for over 20 years we’ve been providing high-dose chemotherapy and stem cell transplant. With that approach, we’ve been able to cure 65% of those with relapsed testicular cancer, and germ cell tumors also, ovarian germ cell tumors.
IU Health has a team of oncologists, a surgeon, and a stem cell transplant expert who provide comprehensive treatment for relapsed/refractory germ cell tumors. The success of our program is that we know what drugs work very well to treat germ cell tumors, whether it’s testicular or ovarian. We have invented the regimen for high-dose chemotherapy using 2 drugs: carboplatin and VP-16 [etoposide]. We offer 2 cycles of that for relapsed and refractory patients. Even in platinum-refractory patients, we can cure up to 25% of these patients when we use high-dose chemotherapy.
In the relapsed patients, we cure up to 65% of patients using 2 cycles of high-dose carboplatin/VP-16, supported by autologous stem cell transplant.
Providing the high-dose chemotherapy is not the only important thing. It is also important to determine what to do after autologous stem cell transplantation. When you’re trying to cure relapsed germ cell tumors, you need a very good oncologist, very good transplant team, and very good surgical team. We have that at IU Health.
Multiple myeloma is a disease that remains incurable. However, when you use very good induction treatment followed by autologous stem cell transplantation in the early setting—you don’t wait on stem cell transplant until later—you can provide your patients with the best remission-free survival and overall survival. Obviously, the advances include offering novel therapy such as CAR [chimeric antigen receptor] T cells early on for relapsed and high-risk patients, the patients who are relapsing in the first 2 years. We will have protocols where we’ll offer CAR T cells with the hope that we can provide them with a complete remission that is lasting, with minimal residual disease [MRD].
How are we going to improve the outcomes of a patient with multiple myeloma? We need to provide novel maintenance or consolidation therapy that depends on enhancing the immune system of the patient. For example, CAR T cells have been very promising in relapsed/refractory myeloma. Why do we wait until the patient is very hard to treat and has disease all over, outside the bone marrow? For these patients who we consider high-risk myeloma patients, we are going to offer them CAR T-cell therapy early in the course of their treatment, where the goal is not just to give remission but to give him a minimal residual disease-negative status. That’s when you start curing patients, when they are MRD-negative.
CAR T-Cell Therapy & Leukemia and Lymphoma
At IU Health we brought on CAR T cells right away, when they became available. We were the only team offering this therapy here, in Indiana. Our goal is to offer the commercial products for CAR T cells that provide control of relapsed lymphoma and acute lymphoblastic leukemia, but we’re actually going further at IU Health. Our goal is to really optimize CAR T cells. The problem with CAR T cells today is the specificity, the safety, the durability. What we’re doing here is we have an active research program. The goal of the program is to try to improve on these things. If the product is not safe, that’s not good. If the product is not lasting, that’s not good. Our goal is to optimize CAR T cells, and we are doing that.
Here at IU Health we have, again, a team of physicians who are not just specialized in modality. They really understand the disease. When somebody comes to see me, or when I treat patients with multiple myeloma, I’m not just thinking about stem cell transplant. I’m thinking about every aspect of myeloma.
The same thing with lymphoma. We have experts on lymphoma. We have experts on leukemia. We have experts on transplant. We have experts on germ cell tumors. So what we have is a multidisciplinary team. We know how to do stem cell transplantation very well. We know how to treat a disease very well.
That’s where we offer great service to our referring physician. We will look at the whole patient, the disease, and try to find the best treatment for that patient. We also have clinical trials available with novel agents that may not be available everywhere. Our team is thinking about how we can get rid of these diseases all the time.
Transcript Edited for Clarity