Multiple myeloma, a campaign to better manage relapses

Multiple myeloma, a campaign to better manage relapses

It is part of the group of chronic lymphoproliferative diseases, with an average age of onset of around seventy years and a slight prevalence in men. Above all, explains Elena Zamagni, hematologist at the IRCCS AOU Sant’Orsola-Malpighi in Bologna, it is still a disease from which one can never say “I’m out of it”. Because it recurs periodically, like the tide on the beaches of Northern Europe, being characterized by alternating periods of remission and the appearance of relapses. It is multiple myeloma, a tumor that affects a particular type of bone marrow cells, plasma cells, i.e. those elements of the immune system that have the task of producing antibodies to fight infections. Every year almost six thousand Italians discover that they suffer from this pathology. Which, just like the waves of the sea, can return at intervals throughout a patient’s entire life. “In fact, it happens that even after targeted therapy some cells prove resistant to the drug and survive, continuing to replicate until giving rise to a relapse,” continues Zamagni. Like a wave that laps the sand again.

Multiple myeloma, the MMarea campaign

It is therefore no coincidence that the communication campaign promoted by Pfizer Italia in collaboration with AIL – Italian Association against Leukemia, Lymphoma and Myeloma, is called “MMarea. Multiple Myeloma. Wave after Wave”. The objective, explains the president of the AIL scientific committee William Arcese, is to inform, support and teach how to manage all phases of the disease, to help patients never feel alone and never lose hope, even when illness makes itself felt again. Heart of the campaign is an illustrated story, created by Manuela Andreani and available on the information website, which tells the story of a fisherman who faces the challenges caused by the tides day by day. The narrative is divided into five chapters which metaphorically describe the five fundamental moments in the lives of people with Multiple Myeloma: diagnosis, therapies, relapse, remission and awareness. A podcast was also born from the illustrated storytelling with the narrating voice of the actor Luca Zingaretti.

“Going back to sea”, after the relapses

“In fact, relapse is the most difficult moment – ​​confirms Zamagni – despite our commitment, as doctors, to remind the patient of this characteristic of the disease. It is as if the information relating to the relapse, which we take care to communicate at the beginning of the diagnosis, was in a certain way removed from the memory of the patients, who therefore find themselves without the psychological strength to face it again after a period of remission. and therefore of relative quiet”. Thus, to help patients face the return of the wave, it is important to gather all their individual and collective potential: affections, friendships, work. “Support at the time of relapse is fundamental – underlines Arcese – and the ability to face this challenge is independent of the patient’s socioeconomic status or level of education. All we need is awareness and a welcoming community able to lend a hand.” Just as happens in one of the episodes of the podcast, when the fisherman who lost everything following the violence of the wave is helped by the inhabitants of his town to rebuild his boat to return to the sea.

Therapies against multiple myeloma

Many different therapeutic approaches are now available against multiple myeloma, none of which, however, represents the “standard of care”. The type of therapy used depends in fact on the phase – initial or refractory relapse – in which the patient is. In addition to chemotherapy and autologous stem cell transplantation, various biological agents directed against neoplastic plasma cells and the bone marrow microenvironment are now available: among these also bispecific monoclonal antibodies such as elrantamab, recently authorized by the European Commission. It is a drug whose target is represented by two molecules: on the one hand the B cell maturation antigen (BCMA), a specific molecule expressed on all plasma cells, but to a greater extent on malignant ones, and which has the function of keeping them alive and differentiating them. The other target is represented by CD3, which is one of the essential molecules for the activation of T lymphocytes, the cells of the immune system whose task is to recognize and kill tumor cells. In this case, the bi-specific antibody carries out an action of “approaching” the T lymphocytes to the neoplastic cells (what is called an “immunological synapse”) to promote their destruction. The results of the studies, published in Nature Medicine, show that in specific categories of patients elrantamab doubles the response rate and quadruples the disease-free time compared to the basket of treatments used in clinical practice.

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