Why Collaborative Care Is Changing What It Means to Live With Multiple Myeloma
At Sylvester Comprehensive Cancer Center, specialists across disciplines work together to deliver more personalized, adaptive care for patients living with multiple myeloma.
Multiple myeloma is the second most-common blood cancer, and it rarely follows a straight path. It evolves over time, responds differently to treatment in each patient and often requires a mix of therapies, including immunotherapies, antibodies, targeted drugs, chemotherapy, CAR T-cell therapy and bone marrow or stem cell transplants.
“Multiple myeloma is not a disease that can be managed in silos,” said C. Ola Landgren, M.D., Ph.D., director of the Sylvester Myeloma Institute and chief of the Division of Myeloma at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. “The best outcomes come from coordinated care that integrates early detection, advanced diagnostics, evolving therapies and long‑term monitoring.”
A Chronic Disease that Requires Coordinated Care
Unlike many cancers, multiple myeloma often behaves more like a chronic illness. Patients may move through cycles of remission and relapse over many years, requiring treatment strategies that adapt as the disease changes.
At Sylvester, physicians, researchers, nurses and supportive care providers in the Sylvester Myeloma Institute collaborate closely with the Miller School’s Division of Transplantation and Cellular Therapy, as well as with colleagues across the Miller School.
“Multiple myeloma patients go back and forth between different types of treatment,” explained Amer Beitinjaneh, M.D., M.P.H., a professor of transplantation and cellular therapy at the Miller School who leads Sylvester’s Transplant, Cellular and Viral Therapy Site Disease Group and collaborates closely with Dr. Landgren. “There is no linear progression, and all the specialists need to communicate constantly. Patients move back and forth between cellular and transplant therapy, the Sylvester Myeloma Institute, infectious disease specialists and more.”
That team‑based structure also allows physicians to closely monitor early and precursor conditions, such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. Careful surveillance at these stages can help clinicians intervene at the right moment and, in some cases, study whether early treatment may delay or prevent progression to active disease.
Complex New Regimens Require Multidisciplinary Planning
“When it comes to multiple myeloma, a lot of novel therapies have been approved, and more are in clinical trials,” Dr. Beitinjaneh said. “Treatment planning can be very complex, and it can be challenging to decide in which order to give each treatment in order to provide a patient with the most benefits, least complications and most longevity.”
For example, Sylvester researchers recently led a clinical trial, called ADVANCE, that established the four-drug regimen DKRd (daratumumab, carfilzomib, lenalidomide and dexamethasone) as a new standard of care for patients diagnosed with multiple myeloma who had not yet received treatment. Stem cells were collected from all eligible patients after four treatment cycles.
After eight cycles, 59% of patients achieved negative minimum residual disease (MRD). Their stem cells were frozen, and those patients moved straight to lenalidomide maintenance therapy. For patients who did not obtain MRD negativity, it was recommended that they pursue a stem cell transplant before moving on to maintenance therapy.
“Patients who achieved MRD negativity had similar clinical outcomes, independent of given therapy,” Dr. Landgren said. “This reflects the fact that multiple myeloma is a heterogenous disease and the disease biology can vary greatly between patients. Some patients do well with slightly less therapy, while others may need more, or different, therapy.”
The ability to coordinate stem cell collection, manage multiple therapy options, track MRD and respond to complications all depend on cross-disciplinary collaboration.
Bringing the Lab and the Clinic Closer Together
Today’s most advanced multiple myeloma therapies depend on a system that can support both clinical complexity and rapid scientific progress. That integration is a central focus for Damian Green, M.D., chief of Sylvester’s Division of Transplantation and Cellular Therapy, the Ron and Nedra Kalish Family Endowed Chair in Stem Cell Transplantation and assistant director of translational research.
“In my research laboratory, we’re trying to develop new immune-based therapeutics for multiple myeloma, and we work in concert with our colleagues in the Sylvester Myeloma Institute,” Dr. Green said. “We have numerous collaborations and publications together, and our research moves back and forth between clinical and laboratory settings as we delve into the mechanisms of treatment resistance and response, improving therapies for our patients and for future patients.”
In parallel, Dr. Landgren’s computational and translational research laboratory is examining tumor tissue from patients in the ADVANCE trial in hopes of understanding why patients responded differently to the regimen, and why some developed resistance.
“For example, we are conducting genomic sequencing of baseline samples and follow-up samples from patients, and we are correlating the data with clinical outcomes,” Dr. Landgren said. “We are also seeking to characterize the immune system of the individual patients to see how that may have played a role in response to therapy and clinical outcomes.”
Ultimately, the goal is to expand the number of patients who respond to therapies.
“We are trying to understand why the new effective therapy we have developed works so well in many patients, but, unfortunately, not in every patient,” Dr. Landgren said. “This information is critically important to us when we develop next generations of translational clinical trials designed to deliver even better outcomes.”
Dr. Green’s laboratory is working with Dr. Landgren and his clinical team. He notes that many of today’s clinical trials have multiple arms. Some patients may receive cellular therapy and others may be randomized to receive a different treatment, or patients might be randomized to receive or not receive a transplant.
“Sylvester is particularly adept at managing these kinds of trials,” Dr. Green said. “Patients get the most expert people managing their myeloma and the most expert people managing their cellular or transplant therapy.”
Advancing CAR T-cell Therapy
This model is especially important for cellular therapies, such as CAR T‑cell therapy, which require seamless coordination across teams. CAR T therapy involves identifying markers on a patient’s cancer cells, collecting their T cells, processing them so they recognize the cancer markers and then reinfusing them so they can attack the cancer. During the roughly five weeks required for T-cell manufacturing, a medical oncologist oversees bridge therapy to keep the patient stable.
“CAR T therapy is a very complex process, with a lot of back and forth between various specialists,” said Dr. Beitinjaneh, who also collaborates with Dr. Green. “It requires strong communication, as well as advanced labs and clinical spaces.”
As the use of CAR T therapies for multiple myeloma has grown and expanded to patients in earlier stages of the disease, Dr. Green has focused his research on making it work for more patients, including approaches designed to make cancer cells more visible to the immune system by increasing the number or density of tumor targets or finding new targets entirely.
Along with Pinar Atilla, M.D., a research assistant professor of transplantation and cellular therapy who works in his lab, Dr. Green has also studied complex biological challenges, such as trogocytosis, a process in which CAR T cells can acquire targets from tumor cells, potentially causing CAR T cells to attack each other. In addition, Dr. Green is exploring next‑generation concepts, such as modifying CAR T cells to remain active, instead of becoming exhausted over time as they fight myeloma, and modifying the immune system more directly to recognize and fight future multiple myeloma.
The team is also looking at why CAR T therapies lead to toxicities for some patients, including infection or, more rarely, neurologic and gastrointestinal complications. Understanding and preventing these effects is key to making cellular therapies safer and more effective.
National Leadership That Strengthens Local Care
Sylvester’s collaborative approach is reinforced by its expanding national role in transplant and cellular therapy research.
In early 2026, Sylvester was designated a Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Core Center, placing it among fewer than 20 centers nationwide selected by the National Cancer Institute to lead multicenter clinical trials in stem cell transplantation and cellular therapy.
Dr. Beitinjaneh serves as the institution’s principal investigator for the grant, which is funded by the National Heart, Lung, and Blood Institute–funded BMT CTN Core Center.
“This designation reflects years of focused effort to build a mature, nationally engaged transplant and cellular therapy program,” he said. “It positions us to help define future standards of care while ensuring our patients have access to the most innovative therapies available.”
Dr. Landgren pointed to what this infrastructure makes possible for patients.
“In addition to all the commercially available drugs, we currently have 29 open clinical trials for patients with multiple myeloma, and we have over 10 clinical trials in pipeline,” Dr. Landgren said. “We are bringing all the latest anti-myeloma drugs — small molecules, immunotherapies and more — to Miami. Our goal is to have great options for all patients who come here, independent of the stage of the disease. Sylvester Myeloma Institute is a world-class leader in early drug development for multiple myeloma.”
Sylvester has also expanded access to specialized transplant and cellular therapy services through UHealth SoLé Mia Medical Center, a new outpatient satellite location in North Miami, bringing highly complex care closer to patients across South Florida.
Longer Lives, More Supportive Care
Collaboration also now extends to patients’ supportive care needs, especially since new treatments mean they can live for 20-plus years after diagnosis.
“Today, in the Sylvester Multiple Myeloma Clinic, we have patients who range in age from their 20s to their 90s,” Dr. Landgren said. “That means we need to involve other specialties to help patients live longer and have better quality of life.”
Disease complications such as loss of bone density or strength may be treated in collaboration with orthopedic surgery or endocrinology, and oral surgeons work with myeloma specialists to address dental health issues. The Sylvester Myeloma Institute and Division of Transplantation and Cellular Therapy work closely with nutritionists to ensure patients avoid foods that can negatively interact with their medications, while focusing on foods that can help both their treatment and their everyday quality of life.
“We also have extremely close working relationships with our infectious disease colleagues, who focus on preventing complications of transplant and cell therapy,” Dr. Green said.
A Commitment to Treating the Whole Patient
At the center of Sylvester’s collaborative care system is a commitment to treating the whole patient over the full course of their life.
“We look at a whole complement of factors to decide which therapy is most appropriate at any given time, to keep the patient in the best health possible for the longest time possible,” Dr. Green said. “Many CAR T-cell recipients are able to stop all therapy for many years. Offering these revolutionary treatments reflects a kind of personalized care that is a hallmark of what we do, and the very foundation for it is the close working relationships among colleagues throughout Sylvester.”
That philosophy extends from the clinic to the laboratory and back again.
“Collaboration is not an add-on,” Dr. Landgren said. “It’s the foundation of modern multiple myeloma care.”
More from the Sylvester Multiple Myeloma Program
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Sylvester Comprehensive Cancer Center faculty gave 155 presentations and four special sessions at the ASH Annual Meeting.
Sylvester Comprehensive Cancer Center’s AI tool, CORAL, predicts genetic subtypes and patient outcomes in multiple myeloma.
Sylvester Comprehensive Cancer Center researchers are investigating ways to eradicate residual traces of multiple myeloma.
Tags: cancer research, CAR T cells, Division of Cellular Therapy and Transplantation, Dr. Amer Beitinjaneh, Dr. C. Ola Landgren, Dr. Damian Green, Dr. Pinar Atilla, immunotherapy, multiple myeloma, myeloma, Sylvester Comprehensive Cancer Center