September is Blood Cancer Awareness Month

September is Blood Cancer Awareness Month raising awareness about the various types of blood cancers, including leukemia, lymphoma, multiple myeloma, and other hematologic malignancies. The goal of this initiative is to educate the public about the symptoms and the importance of early detection and treatment.

Multiple myeloma (MM) is the second most common blood cancer and the most prevalent type of cancer affecting the bones.

MM-related bone disease (MMBD) has severe implications for patients, leading to significant bone loss, intense bone pain, and pathological fractures that greatly impair quality of life and influence survival outcomes. Multiple myeloma bone disease (MMBD) results from disrupted bone remodeling, marked by increased activity of osteoclasts, breaking down bone and decreased activity of osteoblasts (1, 2).

September is Blood Cancer Awareness Month

Daratumumab is a monoclonal antibody used primarily in the treatment of multiple myeloma. It works by targeting a specific protein called CD38, which is highly expressed on the surface of myeloma cells. By binding to CD38, daratumumab helps the immune system recognize and attack the cancer cells, leading to their destruction. Daratumumab is often used in combination with other therapies and has shown significant effectiveness in improving response rates and survival outcomes for patients with multiple myeloma. It is administered via intravenous infusion and may be associated with side effects such as infusion reactions, fatigue, nausea, and increased risk of infections (3).

In the “REBUILD” Study researchers investigated how Daratumumab impacts bone metabolism in patients with relapsed or refractory multiple myeloma. The Phase 2 “REBUILD” trial aims to assess whether treatment with daratumumab can improve bone turnover markers and potentially help repair bone damage associated with the disease. The findings suggest that Daratumumab not only targets myeloma cells but may also positively influence bone health in affected patients (3)

Daratumumab Improves Bone Turnover in Relapsed/Refractory Multiple Myeloma; Phase 2 Study “REBUILD”. Terpos E et al., .Cancers (Basel). 2022.  

Abstract

Biomarkers of bone turnover in serum are suggestive of bone dynamics during treatment in multiple myeloma (MM). We evaluated the role of daratumumab on bone remodeling among patients with relapsed/refractory MM in the prospective, open-label, phase 2 study REBUILD. Daratumumab was administered according to the approved indication. A total of 33 out of 57 enrolled patients completed 4 months of treatment. The median percent change from baseline to 4 months in C-terminal cross-linking telopeptide of type 1 collagen (CTX) (primary endpoint) was 3.9%, with 13 (39.4%) and 11 (33.3%) patients showing at least 20% and 30% reduction in CTX levels, respectively. The median percent decrease from baseline to 4 months in tartrate resistant acid phosphatase 5b (TRACP-5b) levels (co-primary endpoint) was 2.6%, with 10 (30.3%) and 6 (18.2%) patients showing at least 20% and 30% reduction in TRACP-5b levels, respectively. However, the changes in these markers of bone catabolism were not statistically significant. Furthermore, the levels of osteocalcin, bone-specific alkaline phosphatase and procollagen type-I N-pro-peptide (bone formation markers) increased from baseline to 4 months (secondary endpoints) by 18.4%, 92.6% and 10.2%, respectively. Furthermore, the median levels of dickkopf-1 and C-C motif ligand-3 showed a significant decrease at 4 months by 17.5% and 16.0%, respectively. In conclusion, daratumumab improved bone turnover by inducing bone formation and reducing osteoblast inhibition.

 Evaluation of Bone Remodeling

The following serum markers of bone metabolism were measured with

Biomedica ELISA assays:

• Soluble RANKL (BI-20462)
• Osteoprotegerin – OPG (BI-20403)
• Sclerostin (BI-20492)
• Dickkopf-1 – DKK-1 (BI-20413)

 

Discover our Biomarker ELISA Kit Collection

 

Literature

1. Multiple myeloma. Nat Rev Dis Primers. Malard F, Neri P, Bahlis NJ, Terpos E, Moukalled N, Hungria VTM, Manier S, Mohty M.2024 Jun 27;10(1):45. doi: 10.1038/s41572-024-00529-7. PMID: 38937492.
2. Multiple Myeloma and Bone: The Fatal Interaction. Marino S, Roodman GD. Cold Spring Harb Perspect Med. 2018 Aug 1;8(8):a031286. doi: 10.1101/cshperspect.a031286. PMID: 29229668; PMCID: PMC6071546.
3. Daratumumab or Active Monitoring for High-Risk Smoldering Multiple Myeloma. Dimopoulos MA, Voorhees PM, Schjesvold F, Cohen YC, Hungria V, Sandhu I, Lindsay J, Baker RI, Suzuki K, Kosugi H, Levin MD, Beksac M, Stockerl-Goldstein K, Oriol A, Mikala G, Garate G, Theunissen K, Spicka I, Mylin AK, Bringhen S, Uttervall K, Pula B, Medvedova E, Cowan AJ, Moreau P, Mateos MV, Goldschmidt H, Ahmadi T, Sha L, Cortoos A, Katz EG, Rousseau E, Li L, Dennis RM, Carson R, Rajkumar SV; AQUILA Investigators. N Engl J Med. 2025 May 8;392(18):1777-1788. doi: 10.1056/NEJMoa2409029. Epub 2024 Dec 9. PMID: 39652675.