Meet our doctors: Hematologist Amrita Krishnan on multiple myeloma

February 8, 2014 | by

Multiple myeloma, a cancer of the blood plasma cells, is the second most common hematological malignancy in the U.S. (after non-Hodgkin lymphoma), and accounts for 1 percent of all cancers. It is generally thought to be incurable but highly treatable.

Photo of Amrita Krishnan

Amrita Krishnan says new myeloma treatments can help patients lead active, productive lives.

Amrita Krishnan, M.D., director of City of Hope’s Multiple Myeloma Program, says City of Hope is at the forefront of transforming the way myeloma is treated and that, as a result, more myeloma patients are able to live active, productive lives.

What is multiple myeloma and are there any symptoms?

Multiple myeloma is a cancer of plasma cells. Plasma cells are white blood cells that normally produce antibodies to fight infection.

In myeloma, abnormal plasma cells build up in the bone marrow and interfere with the production of normal blood cells. The abnormal plasma cells also can overproduce defective antibodies, which can deposit in the kidneys and damage them.

Kidney damage often can be the first sign of myeloma. Other symptoms include bone thinning and fractures. The abnormal plasma cells also can send signals to the bones and boost the activity of osteoclasts, the cells that absorb or eat bone.

Because the abnormal plasma cells multiply and crowd out normal bone marrow cells, including those that grow to become red blood cells, anemia is a common sign of myeloma.

Are there any known causes or risk factors for multiple myeloma?

Certain chemical and radiation exposures have been linked to myeloma. But in general, most patients do not have an identifiable risk factor.

What are the biggest or newest developments in treating multiple myeloma?

Fortunately, scientists continue to make major advances in myeloma research. Two new drugs have been approved in the last couple of years, and two more are anticipated in the coming years.

Most recently, the U. S. Food and Drug Administration approved the drug carfilzomib for myeloma treatment. The drug’s approval is exciting because it worked even in patients who had previously been treated with similar drugs that failed, including bortezomib. Also, it had a different toxicity profile than bortezomib and caused far fewer cases of nerve damage, a potential side effect of this type of drug.

The most recently approved drug — pomalidomide — is in the class known as immunomodulatory agents, or IMIDS. It appears to work even in patients who are resistant to older IMIDS.

Researchers also are conducting clinical trials of targeted therapies for myeloma and studying the use of engineered disease-fighting cells called T cells to treat the disease.

Where is multiple myeloma research going and what do you think will be accomplished in the next five or 10 years?

We continue to study some of these newer drug combinations and strive to reduce their side effects. Immunotherapy, which is stimulating one’s own immune system to reject and destroy tumors, will be further refined and better defined in regards to the optimal setting for its use (e.g., relapsed patients versus those with minimal disease).

What inspired you to enter into multiple myeloma treatment and research?

What inspires and excites me about the hematology oncology field is knowing there are even more new therapies in development that will have a huge impact on treating this disease. While the survival rate has dramatically improved in the last 10 years, it is rare in the hematology field to see a disease that has made such advances in such a short time. It’s all very exciting.

What advice do you have for patients recently diagnosed with multiple myeloma?

I would tell recently diagnosed patients that there is no one treatment for myeloma. In other words, one size does not fit all. In fact, even the best experts do not agree on which initial therapy is best, the optimal time to do a transplant or the best therapy following a transplant. Rather than view this as frustrating, I view it as confirmation of the many good options now available to patients with myeloma. And here at City of Hope, we tailor treatments for each individual. This personalized medicine always offers the best options and outcomes for our patients.

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For more information about City of Hope's Multiple Myeloma Program, visit cityofhope.org/myeloma.