Unique Features of the Myeloma Institute - University of Arkansas Medical Sciences

The Myeloma Institute for Research and Therapy at UAMS is the largest center dedicated solely to Multiple Myeloma (MM) and related diseases, such as Castleman Disease and Waldenstrom’s Macroglobulemia as well as to prevention and management of potential treatment related consequences, including myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML)

More than 10,000 patients have presented to the Myeloma Institute since the program’s inception in 1989.

More than 90% of patients who present to the Myeloma Institute continue to be actively followed by the Myeloma Institute over the course of their lifetime – many patients have been followed for 20+ years.

Close follow-up of patients assures that our findings regarding treatment outcomes are well-founded. The Myeloma Institute has amassed an enormous treasure of patient follow-up data related to assessment and prediction of outcome, including:

100,000 cytogenetic samples
10,000 gene array samples
50,000 MRIs
25,000 PET scans

Patients referred to the Myeloma Institute, whether referred by a physician or self-referred, are scheduled as quickly as possible, within two-weeks or less.

Every patient receives a thorough diagnostic workup, including gene expression profiling, MRI and PET scan for detection of bone lesions and disease spread outside bone (extra-medullary disease), an increasingly more common presentation in long-term survivors.

The entire Myeloma team meets every week to review diagnostic findings and determine optimal treatment plan for every patient, whether previously treated or untreated.

The team includes MM physicians and nurses, radiologists, pathologists, laboratory and translational scientists.
Challenging cases from the outpatient clinic and inpatient unit are also presented.
The myeloma team also meets every week to review every patient on the inpatient unit.

The majority of treatment is done on an outpatient basis whenever possible.

While in Little Rock, patients and their families are surrounded by kind hospitality and caring support groups. Support groups, led by skilled social workers and patient educators, meet weekly.
Local hotels provide special services and cater to the needs of Myeloma Institute patients.
Patients visit the Infusion Center, staffed by dedicated team of Advanced Practice Nurses, daily or as needed.
Patients are seen by a MM physician weekly or more frequently if needed.
Extensive discharge planning is done for every patient.
Each patient leaves the Myeloma Institute with a detailed plan for follow-up at home.
Designated “phone nurses” in the clinic are always available to answer patient questions.

Many patients are enrolled on clinical protocols, most notably the “Total Therapy” protocols.

The basic philosophy behind Total Therapy (TT) is to use all effective treatments upfront to completely disable the myeloma and minimize relapse.

Protocols have been tailored for various subsets of patients:

Patients with high-risk disease, as defined by Gene Expression Profiling
Patients with low-risk disease, as defined by Gene Expression Profiling
Patients with precursor conditions, such as smoldering myeloma and MGUS (monoclonal gammopathy of undetermined significance)
Patients with renal failure or cardiac complications due to amyloidosis or light chain deposition disease

Assignment to a clinical protocol is based on each patient’s medical history, co-morbidities, and thorough analysis of all diagnostic testing and gene expression profiling.

Patients with MGUS or smoldering myeloma do not need treatment. In those cases, a “watch and see” approach is utilized, along with regularly scheduled work-ups to identify changes or trends in disease markers. MIRT scientists are actively developing molecular and immunological prediction models for determining which patients have a low or high probability for developing active MM that requires therapy.

Patients who are newly diagnosed and who have not received prior therapy are typically assigned to TT4 or TT5, depending on disease risk as identified by Gene Expression Profiling.

For patients who have been previously treated prior to coming to the Myeloma Institute, a thorough review of previous therapies and associated response is conducted. A “best possible outcome estimate” is then made, based on data in the Myeloma Institute’s clinical database. In the event that treatment utilizing high-dose chemotherapy is anticipated, stem cells are collected.

Patients with a history of MM that is resistant to treatment might be eligible for special protocols, such as TT6 with tandem transplants or our immunological Natural Killer Cell protocol or a regimen of novel agents and/or combination of agents, such as Carfilzomib and Pomalidomide.

Other patients with high-risk MM that is resistant to treatment may be treated off protocol and according to an individualized plan. Continual follow-up with MRI and PET is conducted to quickly assess efficacy of therapy and change treatment as indicated.

All of the treatment protocols and individualized therapy approaches at the Myeloma Institute have evolved out of an extensive translational research program, “Growth Control in Multiple Myeloma,” which has been grant funded without interruption by the National Cancer Institute for the past 20 years.

In addition to grant funding from the National Cancer Institute and other agencies and foundations, philanthropic funds are applied to research that is integral to the “Growth Control in Multiple Myeloma” project. Philanthropy has enabled establishment of an extensive Gene Expression Profiling project, a proteomics laboratory, and more.

Translational research is at the core of the Myeloma Institute. Progress made in the basic science lab is “translated” into novel therapeutic regimens, and patient outcome data is funneled back to the lab to support further developments. This back and forth flow between “bench and bedside” promotes creative problem solving and innovation, ultimately leading to optimal treatments.

Also at the core of the Myeloma Institute is an overriding commitment to developing curative treatments and a belief that cure can be accomplished by thinking outside the box and creatively applying scientific and clinical knowledge.