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EHA 2019 | Multiple myeloma: the bone marrow niche

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Irene Ghobrial

Irene Ghobrial, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the bone marrow niche in multiple myeloma and its precursor states as well as the potential treatments that may be derived from this. This interview took place at the 24th Congress of the European Hematology Association (EHA) 2019, held in Amsterdam, Netherlands.

Transcript (edited for clarity):

So every cancer doesn’t exist on its own. The tumor cells don’t exist on their own and they exist within an ecosystem. And the question of the bone marrow microenvironment or the bone marrow niche is critical, especially in multiple myeloma because we know that the cancer cells don’t just grow on their own and they do truly need the support of the microenvironmental cells, and that includes of course the immune cells but also osteoclast, osteoblast, and stromal cells...

So every cancer doesn’t exist on its own. The tumor cells don’t exist on their own and they exist within an ecosystem. And the question of the bone marrow microenvironment or the bone marrow niche is critical, especially in multiple myeloma because we know that the cancer cells don’t just grow on their own and they do truly need the support of the microenvironmental cells, and that includes of course the immune cells but also osteoclast, osteoblast, and stromal cells. And for many years we knew that these are so critical for tumor progression. But now we’re capable of dissecting more of those small numbers of cells and trying to understand how do they contribute to tumor progression, and we’re getting to know the specific subsets of immune cells, macrophages, T-cells are actually essential for that progression. And as we get that information then we can develop therapeutic interventions that can prevent progression in those patients, and potentially harness the immune system so that we can truly understand how can we prevent disease progression, but how to intervene and when to intervene and when to intervene in those patients.

So it depends of course on what we see as a potential contributor to the disease progression, but you can actually envision potentially doing precision medicine using immunotherapy. You can see someone who has a specific subset of macrophages, and these are the ones who are not doing a good job potentially, and then intervening there. Or cellular therapy, potentially; not CAR T in an early stage like MGUS or smoldering, but potentially other cellular therapies. You can think of even vaccination to try and get the immune system to react again and get a better sense of small numbers of cells. And I think the critical thing is at the smoldering state or at MGUS stage the immune system is still intact, and potentially you can use that to harness it and prevent progression in those patients. And it’s probably even more important in those settings, compared to when you have relapse or refractory myeloma.

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