How my training can help address health disparities in multiple myeloma

Group photo with Dr. Ghobrial.

Irene Gobrial (front, center, blue dress) leads an interdisciplinary team addressing health disparities in multiple myeloma at the Dana-Farber Cancer Institute.Credit: Dana-Farber Cancer Institute

Irene Gobrial leads the Stand Up To Cancer’s Multiple Myeloma Dream team, a research charity that investigates the risk factors for this form of bone marrow cancer, which kills 106,000 people each year. Ghobrial, a medical oncologist at the Dana-Farber Cancer Institute and Harvard Medical School in Boston, Massachusetts, described herself as an immigrant to the United States. She explains why translational research is key to advancing personalized therapies and how her team can address health disparities.

What challenges did you face as an early career researcher after moving from Egypt to America?

I graduated in medicine from Cairo University in 1999 and moved to Detroit, Michigan for training opportunities that would not have been available to me in Egypt. I faced many trials and abuses, sometimes driven by discrimination as a woman and a refugee. When you belong to a minority group, your chances of getting into higher education programs are slim. At times, I was oblivious to these obstacles, and not knowing about them helped me persevere and persevere.

I could never have dreamed of this life when I was young. Sometimes I pinch myself and think, “I’m living the American dream, aren’t I?” i say. — as an Egyptian immigrant and woman of color now an associate professor of medicine at Harvard Medical School. But he took the said village. My parents and mentors inspired me to dream big. And despite the barriers to success that minority groups face, the American system still allows people to thrive regardless of where they come from or who they are.

How has being an oncologist influenced the way you do research?

In the year In 2000, I worked in the immunology laboratory run by Karen Hedin at the Mayo Clinic in Rochester, Minnesota, looking at chemokine receptor signaling in immune cells. I have been in love with research ever since. As a clinician-researcher, you can take samples from your patients, perform whole-genome sequencing, get the answers you need, and personalize treatment. This back and forth is fun and exciting.

How did you first become interested in multiple myeloma prevention?

Multiple myeloma is a cancer of the plasma cells, the white blood cells that make antibodies. In myeloma, these cells grow out of control in the bones and produce excessive amounts of abnormal immunoglobulin proteins.

Myeloma affects 160,000 people worldwide every year. Although rare, it is the most common blood cancer in African Americans, who are twice as likely as white Americans. They can also develop it at a young age.

Myeloma may not show any symptoms in the early stages, but people with advanced forms of the disease may have bone pain, fractures, frequent infections, hypercalcemia (higher than normal calcium levels) and anemia.

The situation could not be cured yet. But there are treatments available to help prevent and manage symptoms, slow disease progression, and improve a person’s quality of life. Treatment may include chemotherapy and other cancer-fighting drugs, as well as steroids, bone-modifying drugs, and bone marrow transplants.

I trained at Mayo with Robert (Bob) Kyle, who I call the grandfather of myeloma, who influenced my interest in multiple myeloma. He mentioned two conditions that cause no symptoms but can develop into myeloma: monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).

In the year Instead, he focused on understanding what causes them to develop into myeloma, and stressed that people with the condition should be closely monitored.

How does your team apply its motto – ‘the urgency of now’ – to its daily work?

Our patients need our research to answer their health problems now, not in the next 10 or 15 years. If we can diagnose and treat myeloma early enough, we can make a difference.

My team works fast and hard and performs mass spectrometry to analyze patient samples and send the data back to them. Working this way takes a lot of effort – but it’s also a lot of fun.

My team is interdisciplinary and includes people with MDs or PhDs as well as students. They work in biology, chemistry, bioinformatics, epidemiology, medicine and statistics. Each person in the group is complete with the others.

Tell us more about the Multiple Myeloma Dream Team project.

Our team received a $10 million award and began work in April 2018. Our study, called PROMISE, focuses on understanding these factors to predict the risk of developing myeloma. We screened 30,000 myeloma-prone individuals, including African Americans, African Americans, and first-degree family members with leukemia.

To help potential participants gain confidence and trust in our study, we educate them about multiple myeloma and its prevalence in African Americans, and explain that screening for predisposing factors can improve survival outcomes.

In July 2022, we surveyed 200 African Americans at a health fair event in Indianapolis. A woman is scared because she has a relative with myeloma. After convincing her, she took the test. The results show that within a few weeks, myeloma can develop into kidney failure. So that week we sent her for regular myeloma treatment, which should protect her from myeloma and kidney damage.

What can you tell us about the findings of the PROMISE study so far and their significance?

We have published results.1 The first 7,600 patients were screened by mass spectrometry for monoclonal gammopathies, abnormal immunoglobulins in the blood. We were surprised that 13% of the participants had MGUS, compared to the expected prevalence of 3-5% in the general population.

We also found that another 20% of participants had very low levels of these abnormal proteins, and we named this new condition monoclonal gammopathy of undetermined potential, or MGIP. Now, we are trying to understand what MGIP is. So far, our findings suggest that it may be a marker of early B-cell malignancies – such as chronic lymphocytic leukemia. If so, MGIP can be treated and cured in some people before it progresses to later stage blood cancers. It is exciting to have the potential to better understand MGIP to help prevent the development of blood cancers.

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