Lillian Dameron, then 78, of Holly Lake Ranch, Texas celebrated as the 10,000th patient on Nov. 9, 2011.
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ounded in 1989, the UAMS Myeloma program grew to become a high-patient-volume center known nationally and internationally for its excellence in research and patient care and greatly improved survival. Through its 30-year history the Myeloma Center has pioneered novel advances in diagnosing and treating myeloma and related diseases. Bart Barlogie, M.D., who led the UAMS Myeloma program from its creation until 2014, introduced tandem autologous transplants in myeloma, discovered thalidomide as a novel treatment, and introduced genomic profiling to risk-stratify myeloma into high and low subgroups. “Most people in transplant today do some form of induction, stem-cell transplant, and maintenance therapy afterward to prevent a recurrence of the disease and some incorporate consolidation therapy, too,” said Frits van Rhee, clinical director of the Myeloma Center. The concept first began with the total treatment protocols approach pioneered at St. Jude’s Children’s Research Hospital in Memphis in the late 1970s in the treatment of children with acute blastic leukemia.
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“They were very successful in developing this approach,” van Rhee said. “Back then, this form of leukemia was a fatal disease. Now, more than 90 percent of children are cured. So that’s where this concept of induction, transplant, consolidation and maintenance comes from.” When the benchmark of 40 percent of the children at St. Jude’s achieving complete remission was reached, some of them didn’t relapse and that’s when the first cures were seen. Myeloma is unique in that it is sensitive to highdose treatment. It was thought that high-dose treatment achieved complete remission and perhaps extended the complete remission rate by as much as 20 percent. “So then it was thought, if two in a row were performed, you might achieve remission rates of 40 percent. That’s similar to what is seen at St. Jude’s and that’s where Dr. Barlogie came up with the idea of doing tandem transplants,” van Rhee said. The Myeloma Center continues to offer very extensive therapy in terms of chemotherapy and consolidation and always uses two or three drugs as maintenance. Today, this concept of induction, at least one transplant, and post-transplant therapy with maintenance has been adopted by many treatment centers.
Total Therapy Approach On Nov. 21, 1989, the Myeloma Center launched its Total Therapy approach, the basis for treatment that is now used all over the world. The approach features three or four main phases of treatment and with successive trials, novel drugs are incorporated as they became available. Total Therapy 1 ran through March 1996. “Total Therapy 2 began in 1998 and incorporated thalidomide and in Total Therapy 3, bortezomib was introduced in 2003,” van Rhee said. Total Therapy 4, launched in 2008, was the first clinical trial for low risk-myeloma as defined by gene expression profiling. Total Therapy 5 was the first clinical trial for high-risk myeloma and
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