What does it mean to “thrive” after myeloma CAR T-cell therapy? Dr. Rebecca Silbermann shares her perspective on living well after CAR T-cell therapy and adjusting to a “new normal” after treatment.
Dr. Rebecca Silbermann is an Associate Professor of Medicine and the Clinical and Research Head of the Multiple Myeloma Program at Oregon Health & Science University. Learn more about Dr. Silbermann.
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Transcript
Katherine Banwell:
Dr. Silbermann, welcome. Would you please introduce yourself and tell us about your role at OHSU?
Dr. Rebecca Silbermann:
It’s really nice to be here. I am the clinical and research head of the myeloma program at Oregon Health & Science. The way our program is structured is that my partners and I take care of patients with the full spectrum of plasma cell disorders, including pre-myeloma or MGUS, smoldering myeloma, and active myeloma.
We have some patients that we treat here in Portland, and others that we co-manage with other physicians throughout the state of Oregon, Washington, a little bit of Idaho. And we refer to our colleagues in the cell therapy and transplant programs when it’s time for a patient to consider stem cell transplant or CAR T.
Importantly, those patients generally come back to us after they have completed the procedure, so we get to see them before and after, and to help them throughout that time.
Katherine Banwell:
Dr. Silbermann, this interview is part of the Patient Empowerment Network’s Thrive series. When you think about a patient thriving after CAR T-cell therapy, what does that mean to you?
Dr. Rebecca Silbermann:
It’s a really good question. I think it’s a little bit different for everybody. From my perspective, I want the patient to have more time away from me, and more time away from the clinic. I want them to be able to do the things that they love to do, and to do them at a level that they are comfortable with.
I know that there’s a general hope that CAR T is going to be magic, and that suddenly, the clock is going to be turned back; they’re going to be just as well feeling as they felt before they had ever heard of myeloma. I don’t think that’s the reality for most people.
But I’m hopeful that people can regain some of their strength, regain some of their physical confidence, and go back to focusing on the parts of their life that are not specifically related to the myeloma diagnosis.
Katherine Banwell:
You just touched upon this. Many patients hear the phrase “new normal.” What does that really mean after CAR T-cell therapy?
Dr. Rebecca Silbermann:
I think it’s different for different people. I try to overeducate patients and their caregivers about the breadth of what might happen with the CAR T procedure. Some patients go through with very, very minimal side effects. Others have a tougher course. And one thing that I wish we could do better was to predict who was more likely to have trouble. There are some individuals who we do have hesitation about. We worry that they’re a little bit more fragile, that they might be more prone to some of the post CAR T toxicities.
And for those individuals, I tell them that I would not be surprised if they might notice that fatigue was longstanding, or that their cognition might not remain as sharp as they’ve been used to, and that it might take quite some time to start to see improvements.
The other thing I like to warn people about is that the immunosuppression associated with CAR T is something that can go on for, really, a long time. Even after a person is feeling great, maybe they are feeling back to normal, we often do recognize that they are more prone to infections than they would be if they didn’t have a prior CAR T or a myeloma diagnosis.