In patients with multiple myeloma (a severe form of bone marrow cancer), uncontrolled cell division of malignant plasma cells takes place in the bone marrow. In the Netherlands, about 1,300 patients are diagnosed with this disease every year. Great strides have been made in treatment in recent years, leading to improvements in prognosis. But unfortunately, over time the disease returns.
The aim of this study by UMCG and Amsterdam UMC is to find out whether treatment with CAR T cells leads to a longer disease-free period while maintaining quality of life. UMCG haematologist Tom van Meerten: ‘We will compare treatment with CAR T cells with the current standard treatment in patients with recurrent bone marrow cancer. 126 patients can participate in this study over the next six years, half of whom will receive treatment with CAR T-cells. Current treatment consists of combinations of targeted therapy.'
CAR T-immunotherapy is a relatively new treatment with which good experience has been gained for several years in various stages of different cancers. T cells (a certain type of white blood cells) are taken from the patient's blood. These cells, which play an important role in the body's defence against cancer cells, are genetically modified in a laboratory: a so-called CAR (Chimeric Antigen Receptor) is made from them. This eventually leads to the T-cell (which has become a CAR T-cell after treatment) recognising and attacking the cancer cells. The patient's own immune system is thus tuned to eliminate the cancer cells.
CAR T-cells have been successfully produced at UMCG before. Van Meerten: ‘We have already succeeded in producing CAR T-cells in the UMCG against lymphoma and acute B-cell leukaemia. Thanks to this grant, we can now also start producing specific CAR T-cells against multiple myeloma. The UMCG has all the facilities to make these CAR T-cells ourselves.'
The production of these CAR T-cells is expected to take about eight days from the time the T cells are extracted from a patient's blood. 'This allows us to administer them to the patient relatively quickly. Previously, we sent blood cells from a patient to the United States, which we could then genetically engineer back to the patient weeks later. We can now perform this entirely at the UMCG. This saves valuable time: the entire procedure including transport to and from America took an average of 4 to 6 weeks.'
Besides valuable time savings, this is also expected to deliver quality gains. Because the modification of white blood cells takes place in one place, fresh cells can be used immediately.
The project will start on 1 April 2025 for a period of six years. The Healthcare Institute will use the results of this study to assess whether this treatment can be reimbursed from the basic health insurance package in the aforementioned group of patients. The study is led by haematologists Tom van Meerten and Wilfried Roeloffzen (UMCG) and Sonja Zweegman and Niels van de Donk (Amsterdam UMC).
