Bone marrow cancer has long been regarded as a death sentence. Half of those diagnosed with the disease die within seven years. But that may be starting to change.
Bone marrow cancer
Bone marrow cancer, also called multiple myeloma, is cancer of white blood cells in the bone marrow known as plasma cells.
In 2024, 594 people were diagnosed with bone marrow cancer in Norway. Most people who get this type of cancer are over the age of 60.
"It's revolutionary," says Fredrik Schjesvold, a senior consultant and researcher at Oslo University Hospital.
Not only has the immunotherapy CAR-T recently been approved in Norway for certain patients with bone marrow cancer, as reported by the Norwegian Broadcasting Corporation NRK. In this treatment, blood is collected from the patient, and their own white blood cells are reprogrammed so that they can kill cancer cells.
Another promising type of immunotherapy has received somewhat less attention. Yet it has already been approved in Norway.
It is known as bispecific antibodies and is given as an injection.
Annonse
No need for personalised medicines
The underlying concept behind both treatments is remarkably similar. The goal is to harness the body’s own killing machines, the T-cells.
"These are simply two different ways of getting the patient’s T-cells to recognise cancer cells," Schjesvold explains.
Bispecific antibodies (blue) binds to two different types of cells.(Image: Yuri Hoyda / gritsalak karalak / LDarin / Shutterstock / NTB, edited by Science Norway)
A bispecific antibody functions somewhat like a pair of handcuffs. It attaches to both a T-cell and a cancer cell. This activates the T-cell, which then kills the cancer cell.
There are also trispecific antibodies, which can bind to an additional receptor on the surface of cancer cells.
What is CAR-T?
The CAR receptor can recognise cancer cells.(Image: gritsalak karalak / Shutterstock / NTB)
CAR-T cells are made from the patient's own immune cells. T-cells taken from the blood are genetically modified so they can recognise cancer cells when they are returned to the body.
But unlike CAR-T, treatment with bispecific antibodies does not require blood collection or custom-made medicines. Instead, everything happens inside the body.
"There will likely be years of difference in survival"
New medicines are typically offered to the sickest patients. In other words, those who have not responded to any other treatment. This also applies to bispecific antibodies.
But Schjesvold believes the truly major impact will become apparent when patients who are less ill also begin receiving this form of immunotherapy.
587 patients who had experienced one relapse of bone marrow cancer were divided into two groups. Doctors refer to treatment of such patients as second-line therapy.
After two and a half years, 83 per cent of the patients who received bispecific antibodies remained alive without a relapse. In the group that received standard treatment, only 30 per cent remained relapse-free. The rest had either died or their cancer had progressed.
Because the study is still relatively recent, no one yet knows how long the patients who received immunotherapy will survive. But Schjesvold is optimistic.
"This will probably amount to years of difference in survival. And many of these patients will never relapse, I'm absolutely certain of that," he says.
Expectations have been turned upside down
Annonse
In time, these therapies will likely also be offered as the first choice for patients who have just been diagnosed, according to Schjesvold. This is what doctors refer to as first-line treatment.
At Oslo University Hospital, both CAR-T and various types of bispecific antibodies are now being tested in these newly diagnosed patients. The clinical studies are being conducted in collaboration with the pharmaceutical industry.
Schjesvold believes the effects may be even greater than those seen so far.
"When used as first-line treatment, these therapies are likely to remain effective for even longer. They have completely turned our expectations for survival in this disease upside down and will cure many patients," says Schjesvold.
The jury is still out
But which approach is better? CAR-T or bispecific antibodies?
Schjesvold had long favoured CAR-T, but after attending a medical congress in Stockholm in June, he has changed his mind. Researchers there presented compelling results from aclinical study of bispecific antibodies.
In other words, the question remains unanswered.
"At this point, it's very difficult to say which treatment is best," says Schjesvold.
Different advantages and disadvantages
Each treatment has its own advantages and disadvantages.
For example, CAR-T therapy cannot be started straight away. In the worst-case scenario, some patients die before they are able to begin the treatment.
On rare occasions, CAR-T can also cause very serious side effects, such as cancer.
Bispecific antibodies, on the other hand, can be administered immediately. The trade-off is that patients have to continue with the treatment for the rest of their lives, leaving them more vulnerable to infections.
With more research, it may turn out that patients can eventually stop taking bispecific antibodies, according to Schjesvold. But it's still too early to know for sure.
