How can doctors make both auto and allogeneic transplants better? Using allo transplant is the ultimate in immunotherapy because it replaces a faulty immune system with a healthy one, but it is not used frequently in myeloma because of the potential for fatality from graft vs. host disease (GVHD). Dr. Fowler has done intriguing work at the NIH over a decade to iterate on working solutions to improve the effectiveness of allo while also reducing graft vs. host and is now finding application of his immune therapy in the autologous setting. He discovered that new T cells from transplant donors actually had an impact to kill myeloma cells, not just replace bad stem cells. In the show, he describes that certain T cells have multiple functions. For example, a CD4 cell can both have two types of "helper" functions (Th1 and Th2). Th1 affects inflammation while Th2 kills cancer cells. By manipulating the levels of Th1 or Th2 with a drug called rapamycin, he can reduce GVHD in the allo setting or enhance the myeloma-killing effect of the T cells in the auto setting. Allo transplants are typically for late-stage myeloma patients who are already refractory to chemo, so he has developed both a low-chemo and a no-chemo allo transplant (called "zero-intensity" transplant) that is done as an outpatient service. He uses the rapamycin drug to reduce the inflammation, greatly reducing GVHD complications. He has then brought the same drug to the auto transplant setting, giving a standard autologous stem cell transplant and and then following it with a one-week regimen for four months post-transplant using this immune therapy. The immune therapy is going after all potential myeloma cells, not a particular protein target. To learn more about this fascinating work, click the clinical trials below or read the full transcript.  Clinical Trials Discussed in This Show Allo transplant with rapmycin immune therapy to reduce GVHD Auto transplant with rapamycin immune therapy or rapamycin immune therapy alone without transplant The Myeloma Crowd Radio Show with Dr. Daniel Fowler

Thanks to our episode sponsor, Amgen Dr. Daniel Fowler, MD National Institutes of Health (NIH)