It Takes Two (or More) to Tango with Multiple Myeloma


It Takes Two (or More) to Tango with Myeloma

Tim Gavallas, a police officer in Watertown, Connecticut, used to lead a pretty active lifestyle; he enjoyed lifting weights and running obstacle races, often finishing in the top of the pack. But several years ago, he slowly realized something wasn’t quite right. He started losing weight, and his back began to hurt.

Those symptoms led to a diagnosis of multiple myeloma in 2013, when Gavallas was just 38 years old. He was immediately prescribed a combination of therapies shown to work together to treat myeloma. As a result, things began improving, and within six months he was back on duty full time. He is currently on a different combination but still doing well.

“I’m two and a half years into it now, and I feel pretty good,” Gavallas said. “I can’t lift heavy weights like I used to, but I’m still active and can play with my two young boys.”

Tim Gavallas was prescribed a combination therapy for multiple myeloma following his diagnosis in 2013.

Gavallas is just one of the many patients who are benefiting from a shift in how physicians treat multiple myeloma, as they are increasingly using combinations meant to attack multiple myeloma on multiple fronts.

As the interest in a variety of combination therapies continues to grow, data presented at this year’s Annual Meeting of the American Society of Hematology (ASH) should provide better insight into which groups of medicines hold the most promise.

We’re seeing not only more studies on combination therapies, but also updated follow-up data on the studies we saw last year at ASH.

“We’re seeing not only more studies on combination therapies, but also updated follow-up data on the studies we saw last year at ASH,” Mohamad Hussein, vice president, Global Medical Affairs, Multiple Myeloma at Celgene, said. “Doctors now have more information to help them make the best treatment decisions for their patients.”

Although the potential was initially recognized about a decade ago, only now are researchers seeing the data from studies of combination therapies.

That really speaks to how dramatically new therapies have improved survival over the last decade; with 47 percent of patients now living longer than 5 years after diagnosis, it takes studies at least that long to show that combinations can further improve survival.

The success of combinations doesn’t seem surprising when we consider the complexity of myeloma. Evidence is mounting that multiple myeloma is actually the result of several factors acting together and spurred on by a variety of genetic mutations.

So while one treatment may kill a majority of myeloma cells, other cancerous cells may not be affected at all; those remaining myeloma cells may be the basis of relapse. But combining therapies that target different cell subpopulations could decimate myeloma cell populations that one therapy could never do on its own. Now researchers just need to identify the best combinations.

“Immunomodulators are attractive partners in myeloma combination treatments,” Hussein said. “They enhance the activities of other therapies and their control of the multiple myeloma pathophysiology.”

Although combination therapies are helping transform myeloma into a long-term, manageable illness, we still need to better understand which patients would respond best to which specific combinations.

And since 15 to 20 percent of myeloma patients do not respond well to any of the current treatments—even combinations—we need more options.

New therapeutic classes will lead to new, possibly more effective combinations, which can provide hope for myeloma patients. Gavallas remembers how powerful a bit of hope can be. “When I was first diagnosed, I was scared,” he said. “But then I met someone in my support group who had been living with myeloma for over 15 years because of these new therapies and combinations. At that moment, I felt a huge sense of relief.”


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