Facility Focus: Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center is the world's oldest and largest private cancer center, with over 130 years experience in excellent patient care, innovative research and outstanding educational programs. Based in the heart of New York City and established in 1884, Memorial Sloan Kettering Cancer Center's history of institutional excellence supports a large Myeloma Service.
Led by the new Service Chief, Dr. Ola Landgren, formerly of the NCI, the mission of the MSKCC Myeloma Service is to develop and deliver the best anti-myeloma treatment for today's and tomorrow's patients. Dr. Landgren's goal as Service Chief is to build upon the strength and capacity of the existing facility to create a center of excellence for multiple myeloma and other plasma cell disorders. He intends to build an expansive clinical research portfolio using sophisticated therapies with the goal of curing myeloma. The program will offer a complete boutique of solutions for all stages of patients: MGUS, smoldering myeloma, young, old, newly diagnosed and relapsed/refractory patients and incorporates the use of all new therapies and the already strong use of stem cell transplant, led by Dr. Sergio Giralt.
MSKCC Myeloma Service innovation will focus on three main areas:
1. Myeloma Precursor Stages
The MSKCC Myeloma Service will offer treatments and clinical trials to study and impact early disease progression. Dr. Landgren brings with him deep expertise in MGUS and smoldering myeloma and and will open trials in the near future.
2. Combination Treatments and Immunological Strategies
As myeloma genetics expert Dr. Walter Kuehl states, "The day of immunotherapy has arrived." With a wide variety of vaccines, monoclonal antibodies, T-cell therapies and other immunological approaches now available, the MSKCC Myeloma Service will determine how best to incorporate new immunotherapies with existing treatments and at what stage they should be incorporated. In addition to using available vaccines and monoclonal antibodies in the clinic, MSKCC is also doing CAR T-cell research in-house for use in myeloma. Now that many new "traditional" combination therapies like proteasome inhibitors and iMiDs are available for myeloma, there are many ways they can be combined with new immunotherapies for both early and advanced stage disease.
3. MRD Testing for Individualized Treatment and a Mission for a Cure
Testing for Minimal Residual Disease (MRD) is critical for individualized therapy. Dr. Landgren's intent is to tailor therapy based on presence or absence of Minimal Residual Disease; to use the assessment of treatment response to guide therapies. This is a new, risk-adapted approach that offers lower therapy burdens for lower risk patients. Not all myeloma is the same and not all myeloma patients are the same. For example, if a patient is MRD negative, the patient may move to monitoring only and MRD negative status may prove to be a pathway to a cure. If a patient is MRD positive, then different treatment options may be used. As another example, based on a patient's myeloma biology and their response to treatment, their future treatment can become much more personalized and differentiated.
The program will create a MRD testing center that uses high quality flow cytometry, molecular testing (DNA sequencing that finds monoclonality and uses DNA code to find proteins even in the urine), and whole body molecular imaging. Patients in this program can be tested at MSKCC but treated elsewhere if needed. This deep and exclusive testing will help patients to build personalized intervention strategies.
The Memorial Sloan Kettering Cancer Center Myeloma Service includes team members and their areas of focus:
Dr. Ola Landgren, MD, PhD: Myeloma Service Chief, newly diagnosed, smoldering myeloma and MGUS patients.
Dr. Hani Hassoun, MD: Newly diagnosed, relapsed/refractory myeloma and amyloidosis, light chain deposition disease, POEMS syndrome and Waldenström’s macroglobulinemia.
Dr. Nikoletta Landvai, MD, PhD: Relapsed and refractory myeloma patients using immunotherapies, including those that target Cancer-Tesis antigens.
Dr. Sergio Giralt, MD: Leads the Adult Bone Marrow Transplant Service. Expanding the age for transplant based on new safety techniques and minimization of host vs. graft disease.
Dr. Heather J. Landau, MD: Treatment of multiple myeloma and light chain (AL) amyloidosis. Lowered toxicity strategies for transplant, including the use of out-patient stem cell transplants.
Dr. Guenther Koehne, MD, PhD: Stem cell transplant expert including allogeneic transplant for high-risk multiple myeloma, leukemia and lymphoma. Pioneering a new type of stem cell transplant using T cell-depleted transplants to reduce graft vs. host reactions.
Dr. David J. Chung, MD, PhD: Stem cell transplant expert and immunotherapy research focused on dendritic cells and their interaction with immune system cells.
With the doctors, the full team of nurse practitioners, research nurses, support nurses and other staff, the Myeloma Service provides excellent care for multiple myeloma patients and is prepared to push the envelope for myeloma innovation.