Redefining Cancer Care: Dr Adeel Khan's Revolution in Myeloma Treatment

Multiple Myeloma Advances: Dr. Adeel Khan on New Treatments, CAR-T, and AI in Research

Season eight of Villages Vitality Life: Senior Life Unscripted features host Mike Roth interviewing Dr. Adeel Khan, a hematologist-oncologist and epidemiologist at UT Southwestern and director of myeloma epidemiology research and a monoclonal gammopathy precursor clinic. Khan explains multiple myeloma as a plasma cell cancer common in older adults (median onset 69) and notes rising prevalence as patients live longer, with median survival improving from about three years in the 1990s to over nine to ten years today. He outlines treatment evolution from older chemotherapies to targeted drugs and newer immunotherapies, including CAR-T (ide-cel and cilta-cel), citing 2025 ASCO data suggesting some long-term remissions that may be curative. They discuss AI analyzing genomic data, unclear prevention and risk patterns, possible benefits of plant-based diets, early MGUS/GLP-1 data, and how to contact UT Southwestern (214-648-3111).

00:00 Season 8 Welcome
00:39 Meet Dr Adeel Khan
01:46 Why Blood Cancers
03:13 What Is Myeloma
05:04 Treatment Breakthroughs
07:25 Immunotherapy And CAR T
10:41 Long Term Remission Stories
11:38 Sponsor Health Tip
13:19 AI And Genetics Research
15:09 Risk Factors And Prevention
17:04 Diet And GLP 1 Questions
18:56 Clinic Contact Info
20:11 Final Thoughts And Sign Off

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Transcript

Redefining Cancer Care: Dr Adeel Khan's Revolution in Myeloma Treatment

[00:00:00] Dolores: Welcome to Season eight of Villages Vitality Life, Seniors life Unscripted. In this new season, we talk to leaders of clubs and interesting folks who live in and around The Villages. We also talk to people who have information vital to seniors. You will get perspectives of what is happening in and around The Villages, Florida, in addition.

We will add more information for all seniors. We are a listener supported podcast.

[00:00:35] Mike: This is Mike Roth on Villagers Vitality Senior

 Life Unscripted. Today  I'm here with Dr.Adeel Khan.

Thanks for joining me, Dr. Kahn.

[00:00:43] Adeel Khan: Pleasure to be here, Mike.

[00:00:45] Mike Roth ai5: He is a Hematologist oncologist and an epidemiologist. He serves as an assistant professor of medicine and public health at the University of Texas Southwest Medical Center in Dallas. He is the director of a myeloma epidemiology research and clinical director of monoclonal 

Gammopathy Precursor Clinic. He's a graduate of the University of Michigan Medical School. Harvard, TH Jan School of Public Health, Columbia Mailman School of Public Health. Thanks for joining me again.

[00:01:24] Adeel Khan: Thanks so much for having me. And I'm you know, pleased to have so many syllables in my titles. Thanks so much for the introduction, Mike.

[00:01:30] Mike: You're one of the longest titles I've ever had to put into the show. Did I mispronounce any of the words too badly?

[00:01:36] Adeel Khan: It, it's epidemiology but yeah, and then myeloma. But yeah, a lot of lengthy terms there, and that just, I think, speaks to how ,specific in some ways my field is.

[00:01:46] Mike: So with that kind of a background in education, Adeel what made you go into the field of blood cancers?

[00:01:54] Adeel Khan: Yeah. It's a great question, and I I think growing up, I was always very interested by cancer in general, you know, things that had touched my own life with family members. And my interest in medicine was, was pretty early on, you know, really from grade school up. And in part, I think I was influenced by my parents, both of whom are, are doctors, different types but, but doctors.

And when I got to medical school, I found the blood cancers just to be so fascinating just because of how much research there was in the field, how how much there was the ability to now change people's outcomes in, in a positive light. And so while people going through their medical journey often change their minds a lot of times, from my second year of medical school, I said I wanted to do blood cancers, and I never looked back.

And so that is something I have stuck with, and I'm very happy to be in the field now and to make my, my humble contributions.

[00:02:44] Mike: Did you grow up in the Texas area?

[00:02:46] Adeel Khan: I grew up mostly in Oklahoma, but I lived around, so I lived between New Hampshire, New York And Massachusetts, and that pinball settled eventually in Oklahoma, where I-- These are where my formative years were then, b- from middle school, high school, and college. And so when I was wrapping up then my medical training and public health training, that was in Boston, and my, my wife and I were, were, we welcomed our first child. We wanted to be closer to home, which to us was the southwestern region, so we've been very pleased to be here.

[00:03:13] Mike: Now you specialize in multiple why should seniors care about this blood cancer disease?

[00:03:20] Adeel Khan: Yeah. So multiple myeloma is is a specific blood cancer that has become increasingly common for kind of interesting reasons. So for one, I'll say it's sort of a funny name. The name multiple myeloma is one that has been historically what it's been called for decades and decades. But really what it is is that it's, it's plasma cell cancer.

So plasma cells are types of-- a type of white blood cell that's in all of us that live primarily in our bone marrow, and they're responsible for making antibodies. And when become-- when they become abnormal, they don't stop making antibodies, but they start making altered ones, and that's what we call M proteins or monoclonal proteins, but it's something that we can measure.

And when they become so significantly abnormal that they're cancerous, that situation of plasma cell cancer is really what we call multiple myeloma or simply just myeloma. And it's one that historically was not that common. It was about number fourteen or fifteen most common in terms of incidence in the United States and still hangs around that.

But it's become increasingly prevalent because people live longer and longer with the therapies and the treatments that we have now to the point where now globally it actually is the second most common blood cancer worldwide. And it's--

[00:04:37] Mike: Second and most common,

[00:04:38] Adeel Khan: That's right.

[00:04:39] Mike: and the most common is,

[00:04:40] Adeel Khan: Most common de--

[00:04:41] Mike: leukemia.

[00:04:42] Adeel Khan: Usually CLL chronic lymphocytic leukemia, also called small lymphocytic lymphoma, is usually what's considered number one in that category.

And number two now by most cancer epidemiology metrics has become multiple myeloma over the past roughly ten years. And myeloma...

[00:05:01] Mike: Of, for multiple myeloma now?

[00:05:03] Adeel Khan: Absolutely. You know, so, so for one, m-multiple myeloma is a cancer of the, the older adults, so the median age of onset is sixty-nine years old, and treatment has been historically a challenge.

And I'd say that this has been the case up until kind of the drug revolution that we've had really somewhere around like the kind of the mid-twenty-- two thousands to twenty tens and beyond, where conventionally treatment was given with kind of whole harsh old-fashioned chemotherapies. And this worked A little bit, you know, this was really before my, my era in the field.

It worked definitely a little bit, you know, and those were contributions that some very wise individuals made. But really nowadays with the targeted therapies that we've had, we have been very much able to expand survival and meaningful quality of life to years and years beyond what it was just decades before.

So if I give some numbers to it, the median survival for multiple myeloma in kind of the era past, so talking about like '90s for instance, was about three years. Three years for all comers with multiple myeloma. And then from around the--

[00:06:09] Mike: is it?

[00:06:10] Adeel Khan: So nowadays it's, it's in excess of nine to ten years median survival, so over triple.

And there are some people who essentially live with it as sort of just a chronic disease. It's something that just lives with them. And because we've had so many successful treatments, when something doesn't go well, we can move them down to another line and so on, and it gives them meaningful quality of life.

[00:06:32] Mike: What are those treatments?

[00:06:33] Adeel Khan: So in, in the days long past, it was again kind of an old-fashioned what we call cytotoxic or classical chemotherapies. These were what we call alkylating agents, so oral melphalan kinda old stuff that people stereotypically think about as chemotherapy. The nausea was prominent, hair loss, that sort of thing.

And because plasma cells are a very specific type of cell, in a way they've been pretty exploitable. They just have some unique features that make them a little bit more particular, and those are just different avenues for possible treatments. So now we have still a lot of so what we call conventional treatments, and these are things like immunomodulatory drugs like lenalidomide, pomalidomide.

We've had that for years and years. We call proteasome inhibitors like bortezomib or carfilzomib. Again, we've had those for years, and those have worked well. And then what's really started to change the game were the immunotherapies, and these are treatments that are able to harness a patient's own immune system against the multiple myeloma cells themselves and has shown fantastic efficacy since their onset in the scene around five, six years ago.

[00:07:42] Mike: Those are the latest treatments.

[00:07:44] Adeel Khan: Yeah, absolutely. And, and they come in basically two broad flavors. So when we talk about the immunotherapies in, in multiple myeloma, and this is very similar to other, other cancer types as well, but we have, we have two broad categories that, that we speak of. One is that we have the, the cellular therapies, and then the other we have what we call the bispecific antibodies, and I'll delve more into both of them.

So the cellular therapies, and the specific one I'm talking about here is CAR-T therapy. CAR-T therapy has really been a game changer for multiple myeloma, and it's CAR-T

[00:08:16] Mike: t.

[00:08:17] Adeel Khan: exactly. Chimeric antigen receptor T cell therapy. And again, a lot of syllables. What is going on with that? And it's a treatment where we take someone's T cells, we, we phores them out, and we send them to a manufacturer, and that can be a different number of, of company depending upon the product.

And what they do is that they then bioengineer those T cells from the patient into CAR-T cells by basically putting a different receptor on their surface that can target some molecule on the multiple myeloma cells. And in converting it to CAR-T cells, that becomes a bonafide treatment in and of itself.

And then we take a patient, say, "Okay, the CAR-T cells are ready. Let's... It's go time." We give them a different type of chemotherapy to just knock down some of their native white blood cells so that in a sense the CAR-T cells have space to take up residence. You infuse those in, and then that's essentially it.

You just watch after that. Manage sort of any untoward side effects that can come up. There are things that can happen. But that ends up being a, a, a treatment in and of itself, and it can give people years and years and years. And there are two FDA products FDA CAR-T products that we have approved.

One is called ide-cel, the other is cilta-cel. And ide-cel is, is also called the baqsimi by Bristol Myers Squibb. That was the first one. The other one is cilta-cel, which is also called Carvykti, and that's made by Johnson & Johnson. And we had data presented last year at our American Society of Clinical Oncology conference in June of twenty twenty-five that showed that in some select patients who get cilta-cel, they have a long-term remission that appears to be essentially curative.

Looks like a cure. I say that with quotation marks here, even at five years beyond this treatment.

[00:10:00] Mike: enough term test to prove that

[00:10:03] Adeel Khan: Exactly.

[00:10:04] Mike: cure.

[00:10:04] Adeel Khan: Exactly right. And, that really has been just a game changer because for one, historically, and this goes all through my training, myeloma was felt to be incurable. Increasingly treatable, very treatable nowadays, right?

We've got, like I said, you know, survival's over tripled for, for most patients that people can do very well. But we still felt like the cure word was elusive. We just didn't have that C word attached. And now the gears have really started to shift where we think that, you know, probably in a good select number of cases, certainly not everyone, but we might actually be able to cure these folks.

And that's just, you know, a phenomenal improvement and just a great service for patients.

[00:10:41] Mike: Sure. How many years is the longest cure that you have now?

[00:10:44] Adeel Khan: Well, there, there are some people who have decades and decades and I'll give one famous example. What a great patient advocate who was actually one of the heads of one of the multiple myeloma foundations Gilad Baru, he has had multiple myeloma in his... And he speaks about this, so I'm not, you know, revealing something that's, that's secretive.

He speaks of his journey. He was diagnosed in his twenties, and he's around sixty now.

[00:11:10] Mike: Wow. So he is had 40 years

[00:11:12] Adeel Khan: I mean, he's, he's had a

[00:11:13] Mike: that was

[00:11:13] Adeel Khan: fan...

[00:11:14] Mike: cart t

[00:11:15] Adeel Khan: He's, he's had a number of treatments, you know, all through that time. He's kind of been through different eras of therapy but it speaks to what success can be. Now, now that is atypical.

I have to-- I do have to caveat that. But it-- the fact that it's possible and that we have someone as prominent as him who, who shares his journey and has been able to, to advocate for his fellow patients in that manner, it, it just shows you what the field can do and what we hope to do more and more of.

[00:11:38] Mike: Okay, let's take a short break now and listen to what Dr. Craig Curtis talk about give us a tip on Alzheimer's disease, maybe even Parkinson's. 

[00:11:48] Dr. Craig Curtis: When we talk about the causes of heart attacks and strokes and peripheral vascular disease, we all know about things such as diabetes, smoking, and poor diet choices. Those are all called modifiable risk factors. You can change those and you can lower your risk. And then if we talk about non-modifiable risk factors, things you cannot change.

There's a cholesterol that has been labeled. The ghost cholesterol. I've heard of good cholesterol and bad cholesterol. Now I have to worry about a ghost cholesterol. That's right. There is a cholesterol known as lipoprotein A, that cholesterol has been known about for a long time. However, scientists over the last decade have discovered that this is one of the major.

Risk factors for heart disease, cardiovascular disease, cerebral vascular disease, such as strokes and peripheral vascular disease, such as problems in the legs. And what they've discovered is that this is a genetically linked lipoproteins. What that means is. It runs in families, and unfortunately, we've had no way to modify this.

[00:13:07] Edward: To learn more, visit his website, CraigCurtisMD.com, or call 3 5 2 5 0 0 5 2 5 2 to attend a free seminar.

[00:13:17] Mike: Thank you, Dr. Curtis. I'm back with Dr. Aade Khan. Dr. Khan. In the current state of research on multiple melanoma how are you guys u doctors AI to better outcomes?

[00:13:33] Adeel Khan: Yeah. So, y-you know, artificial intelligence has had its, its hands in different ways all across the research spectrum. And, you know, I think some of the most interesting things that we're doing now is in some of our, our drug development and and then backing up maybe before that in more of the, what we call the basic science realm, and just trying to understand myeloma cells a little bit more.

So as time has gone on, we've had a lot of data sitting around myeloma, and with some of the studies that we get from patients, we really can have, you know, down to the level of specific mutations in a, a given myeloma cell. That's what we call next generation sequencing or NGS. And it's something that we can run off when we do the diagnostics on a patient to then see in the, in those myeloma cells, what are...

We do genome sequencing, we look, what are all the alterations that we could characterize? And there are billions of possibilities, quite frankly. And a lot of those are not known to be actionable. It's something that we, we see and, you know, it's a great fascination. We don't know what to do with it because, one, there's just so many possibilities.

Two, again, what do you do with them, right? Are, are they something that are exploitable targets? Are they just kinda incidental? We don't know. And so there's been a lot of interest in taking AI to help us sift through that, to actually delve into patterns and see does that tie to patient outcomes? Does that tie to certain sociodemographic factors?

Do we just see some things more common in this domain X versus that domain Y that might help us understand what's going on with those myeloma cells a little bit better That's very much within the research realm.

[00:15:09] Mike: There anything that seniors can do to avoid melanoma?

[00:15:13] Adeel Khan: It's a great question and one that's had a lot of interest over over the years. The, the short answer is that we don't know. So there, there's, there's a lot of there's a lot of unknowns still in what happens with multiple myeloma in what we call myelogenesis, like why does it happen? It seems to be kind of a random event in those white blood cells, those plasma cells, and about fifty percent of cases seem to be traced to something that happens on chromosome fourteen in a specific area of a gene that is involved with antibody production.

Now again, why that happens, we don't know, and that's still roughly about fifty percent, so that's, that's by no means characterizing all cases. And then we see some...

[00:15:53] Mike: run in families.

[00:15:55] Adeel Khan: Yeah. And, and then we see like this clustering in families and, and a certain kind of racial ethnic pattern too that has not been well explained.

So for instance, if you have a first fam... first-degree family member with multiple myeloma or a similar what we call monoclonal gammopathy, a precursor to myeloma condition, your risk ends up being roughly about twofold, and, and why that is is not clear. And then we see again some other patterns too.

There's way more myeloma in, in certain racial ethnic sex groups than others. So we see more in males than females. We see it more in people of African American or, or, or African ancestry and then less in Asians and then in people of more Hispanic ancestry, sort of up and down the spectrum. And, and why that is is not really clear.

So

[00:16:42] Mike: You

[00:16:43] Adeel Khan: these...

[00:16:43] Mike: a clear trend.

[00:16:45] Adeel Khan: I certainly don't. I think whoever figures that out is gonna be very famous, but we just don't know. But we've seen that in, in numerous studies, and it speaks to the fact that, again, there's just probably stuff we just don't know about it and, and there's a pattern that we... that has been lurking that we haven't been able to characterize.

So hopefully more to come in the years as we delve more into it.

[00:17:04] Mike: Diet play any role in controlling the disease after diagnosis?

[00:17:09] Adeel Khan: In, in, in a classical sense we don't know that it formally does, but I will say that we, we increasingly think that there is definitely a role for some lifestyle aspects. And we have some work done out of Memorial Sloan Kettering, one of, you know, our nation's preeminent cancer hospitals, where they looked at people with multiple myeloma who were given more of a plant-based diet compared to what their...

were their conventional dietary habits, and they did see advantages within their disease. Now, it's, it's still early data but they've done some single cell analyses showing that There does seem to be some benefit. Now, whether that is specific to the disease per se or the fact that when we make certain dietary food like this across all kinds of diseases we see benefit, that remains to be seen and it's still a very active area of research.

But I think no one does poorly by having a better diet and lifestyle. So I think there, there's reason to be thoughtful of that regardless of whether it specifically helps myeloma per se.

[00:18:11] Mike: And the other question that comes up these days is do the GLP one medicines help or hurt in the treatment of myeloma, multiple myeloma.

[00:18:21] Adeel Khan: A-and interestingly, we have one paper that looked at a precursor to multiple myeloma, something called M-G-U-S, MGUS, which, a-again, a lot of syllables here, stands for Monoclonal Gammopathy of Undetermined Significance. And MGUS is a, is a way... very early precursor to myeloma. And in this paper they did see some vague benefit to GLP-1s, but, you know, it's, it's not clear that that's causal at all, that it actually is causing the benefit or it's just the fact that that promotes a healthier weight and healthier situation for the patient in general.

Much more to be seen as time goes on.

[00:18:56] Mike: Now if someone suspects that they have. Have this disease or been diagnosed with one of the precursors, is there any way they can contact you or get more information

[00:19:07] Adeel Khan: Absolutely. Absolutely. You know, so we, we have a specialized clinic that we focus on multiple myeloma as well as actually its, its precursor conditions. That's that monoclonal gammopathy precursor clinic. And a lot of the other big cancer centers nationwide have similar ventures there, all as a service to patients that as we recognize that there's more and more people with myeloma and those precursor conditions, this is a way to, to serve people.

So yeah, absolutely. You know, and we are always looking for, for people one, to serve to help us with our, our research and to see if we can continue to move the field forward.

[00:19:42] Mike: Is there a number telephone number that people can call

[00:19:44] Adeel Khan: Mm-hmm.

[00:19:45] Mike: like to call instead of looking at a website?

[00:19:47] Adeel Khan: Absolutely. We can put that in, in, in the show notes as well. We, we also have some digital referral mechanisms, so there's, there's plenty of ways to, to get ahold of us. What I'll also say is that depending upon where someone is located there are other similar clinics that can serve people here, but our, our general phone number for UT Southwestern is two one four six four eight three one one one

[00:20:10] Mike: Good. Dr. Con, is there anything that I should have asked you that I've forgotten to ask you?

[00:20:16] Adeel Khan: I, think what I would like to say is the field of myeloma is, is interesting. I think it's very relevant for seniors because of the fact that this is a disease largely of older adults. Great strides and improvements including just so much more in the pipeline that would be a whole other podcast.

So in our pursuit of trying to attack this disease it, it's really been a pleasure of mine to be able to serve people in the field to, to move it forward. And I think the next few years we're going to see even more advancements as we have so many more of these immunotherapies and carge-targeted therapies coming down the, the pipeline.

[00:20:48] Mike: I wanna thank you for being with us today, Dr. Kahan,

[00:20:51] Adeel Khan: Thank you so much for having me, Mike. It's been a pleasure.

[00:20:53] Mike: stay in touch with you, if you had come up with any more

[00:20:56] Adeel Khan: do. Please do.

[00:20:58] Mike: Good. Thanks. 

[00:20:59] Dolores: Remember, our next episode will be released next Friday at 9:00 AM. Should you wanna become a major supporter of the show or have questions, please contact us at mike@rothvoice.com. This is a shout out for supporters, Tweet Coleman, Ed Williams, Duane Roemmich, Paul Sorgen, and Dr. Craig Curtis at K 2 in The Villages.

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