Dr. Hearn Jay Cho Answers Questions About Blood Cancer And Immunotherapy After the 2021 CRI Virtual Immunotherapy Patient Summit

At the CRI Virtual Immunotherapy Patient Summit in October, patients and caregivers were eager to further their understanding of immunotherapy. 

Hearn Jay Cho, MD, PhD, associate professor of medicine at the Icahn School of Medicine at Mount Sinai and chief medical officer of the Multiple Myeloma Research Foundation, led the Blood Cancer and Immunotherapy session. 

We followed up with Dr. Cho after the event to discuss several more questions from attendees.

Is it possible to have liquid biopsies from regular blood or serum to find myeloma markers such as NGS or NGF without invading Bone Marrow Biopsies by using Mass spectrum in the future?

First, there are developing technologies for “liquid biopsies” in myeloma, which will isolate either circulating tumor DNA or circulating tumor cells to examine genetic features of the tumor, similar to FISH and cytogenetics on the bone marrow. These are unlikely to completely replace bone marrow biopsies, but they may reduce the number of these procedures needed during the course of myeloma treatment. 

Second, there are a number of new technologies to assess “minimal residual disease” in myeloma. Many of these require bone marrow biopsy, however, a new technology using mass spectroscopy to identify even minuscule amounts of M-protein in peripheral blood is currently under investigation. 

Is next-generation sequencing advantageous to treatment protocol selection?

There are a number of clinical trials currently underway, such as the NCI MATCH and the MMRF MyDRUG trials that use next-gen sequencing to identify certain mutations that can be targeted with specific drugs. These trials will hopefully advance precision medicine in cancer and lead to the adoption of next-gen sequencing.  

I have been in remission since my stem cell transplant in January 2016. Can you participate in a clinical trial if you are in remission?

As far as I know, there are no clinical trials for patients who have been in remission for a long time. 

I have blood cancer and colon cancer. Can immunotherapy help with both cancers or will it just help one cancer at a time?

It depends on what kind of blood cancer. Immunotherapies that are commonly used in colon cancer, such as immune checkpoint inhibitors, are also approved for Hodgkin’s lymphoma. Some of the chemotherapy agents used in combination with checkpoint inhibitors also work for both solid tumors and blood cancers. 

Do adolescent or young adult patients have 'the same' reactions to immunotherapy as pediatric and adult patients? 

In general, the side effect profiles and response rates for immunotherapy agents are similar in all age groups. However, younger patients may tolerate some of the side effects better.

If immunotherapy trains a T cell to identify a cancer cell, does that mean that there are fewer T cells available to identify and fight viruses?

No. Fortunately, the immune system has the capacity to support a diverse population of T cells. However, immunotherapies that are directed against blood cancers often also reduce normal immune cells. For example, we are learning now that blood cancer patients on treatment often have reduced or absent immune responses to vaccines. 

How long will I be followed after immunotherapy treatment? Are there any survivorship programs for cancer patients I should be aware of?  

In general, patients who achieve complete remission after immunotherapy are stilled followed indefinitely. This may be an annual checkup or more frequent, depending on the disease. There are communities and support groups that are commonly organized around disease types. 

Learn more about immunotherapy for blood cancer