Rafael Fonseca, P. Leif Bergsagel, Keith Stewart

Left to right: P. Leif Bergsagel, M.D., Rafael Fonseca, M.D., and Keith Stewart, M.B.Ch.B.

If you were diagnosed today with multiple myeloma — a cancer of the plasma cells -- your physicians would have only a few treatment options. The disease is the second most common blood cancer in the United States, with 15,000 new cases each year. Yet treatment is characterized by a one-size-fits-all approach. Researchers at Mayo Clinic are determined to change that.

"Right now, treatment for multiple myeloma is not personalized," says P. Leif Bergsagel, M.D., one of the lead researchers in Mayo Clinic's Multiple Myeloma Research Program. "Our goal is to deliver individualized care based on the latest genomic information and drugs available. We intend to find ways to offer the right drug to the right patient each time. That's the future of all medicine. But in myeloma, we're set to be one of the first areas to make it happen."

To help move this goal from vision to reality, Mayo Clinic brought together a team of Dr. Bergsagel, Rafael Fonseca, M.D., and Keith Stewart, M.B.Ch.B., to lead its myeloma research in Arizona. Their work spans the continuum from laboratory research to patient care.

Mayo's approach to research makes it uniquely positioned to translate medical discoveries into effective treatments. Most Mayo physicians are involved in both patient care and research, allowing them to apply the latest discoveries to patient care and to use their experience with patients to help guide explorations in the lab.

Dr. Bergsagel is exploring the genetic changes that can cause myeloma. Dr. Fonseca is researching the significance of those changes and their potential effect on treatment. Dr. Stewart is working to identify drugs that will fight the disease, depending on an individual's genetic markers.

"Patients ask three questions when they find out they have cancer," says Dr. Fonseca. "'What do I have?' 'What will happen?' and 'What can we do about it?' We're working to answer those questions. Dr. Bergsagel is identifying what you have. I'm the one who works with you to figure out what's going to happen. Dr. Stewart can show you what to do about it."

This unique collaboration complements the work of world-leading myeloma researchers at Mayo Clinic's Rochester campus. Through their combined efforts, the Multiple Myeloma Research Program is poised to revolutionize the way patients and physicians deal with a multiple myeloma diagnosis.

"We're looking to have global impact. We want to see that what we do shifts the way people view multiple myeloma," says Dr. Stewart. "At the end of the day, it's about changing the way this disease is treated across the world."

International expertise
With its inception in September 2004, the Multiple Myeloma Research Program in Arizona is still new. But at its core are three researchers, each internationally recognized for advancing the study of genetics in multiple myeloma.

Before coming to Arizona, Dr. Fonseca spent 10 years at Mayo Clinic in Rochester. Dr. Bergsagel was with Weill College of Medicine at Cornell University, and Dr. Stewart was at the University of Toronto. Their paths crossed frequently at international conferences and gatherings of myeloma researchers. Throughout a decade of interaction, common interests drew them together. They collaborated on research, co-authored papers and became good friends.

In 2004, Dr. Fonseca moved to Arizona to begin Mayo's Multiple Myeloma Research Program there. He invited Dr. Bergsagel and Dr. Stewart to join him. It was the perfect opportunity to take their work to the next level.

"Marrying the reputation of Mayo Clinic with the reputations of my two colleagues made the choice to come here an easy decision," says Dr. Stewart. "The concept of actually sharing a laboratory with these two was too good to pass up. I really think working together, we'll make huge inroads into this disease."

"Our collaboration is rooted in similar research interests and friendship," says Dr. Fonseca. "We believe we can gather our strengths to deliver on the ideal of taking genomics from the laboratory to the clinic."

Critical support
Adding substantial backing to the program is Mayo's 60-year tradition of expertise in multiple myeloma, as well as the infrastructure of Mayo's nationally recognized cancer center, which includes staff at all three Mayo Clinic locations.

Mayo Clinic's Cancer Center has been a National Cancer Institute-designated cancer center since 1973. In 2002, the National Cancer Institute expanded the cancer center designation from Rochester to all three Mayo Clinic locations. This expansion allowed for the growth of cancer center programs to Mayo Clinic in Arizona and Florida. The Multiple Myeloma Research Program was part of that growth.

"Mayo Clinic has a long history of expertise in this area," says Dr. Fonseca. "This program is meant to build on Mayo's existing strengths. We work closely with a large group of clinical and research colleagues throughout the cancer center. We think of ourselves as one Mayo Clinic, even though we are in different locations."

The multiple myeloma researchers at Mayo also collaborate with colleagues at the Translational Genomics Research Institute (TGen) as they explore the disease, genomics and drug development. Staff from both groups work in the new Mayo Clinic Collaborative Research Building and interact on a regular basis.

"TGen is at the forefront of applying new genetic techniques to study patient problems," says Dr. Bergsagel. "They have access to the newest technology that we otherwise wouldn't get until a later time. We provide the clinical setting in which to apply the science in order to solve patient problems. This collaboration allows both groups to work to our mutual benefit."

Patient benefit
Although still in its early stages, the Multiple Myeloma Research Program has already shown results. In October 2005, one of the first personalized therapies for multiple myeloma was approved for a clinical trial at Mayo Clinic. It was based on genetic research conducted by Dr. Fonseca, Dr. Stewart and Dr. Bergsagel.

"This is the first of what we hope will be a series of individualized therapies for patients," says Dr. Bergsagel. "Right now, this work is in its infancy. But we are beginning to understand and take advantage of the potential of genomics in multiple myeloma, and we have new drugs that were never available before. It's an exciting time."

Looking to the future, Dr. Stewart sees the program growing to become an international leader in multiple myeloma, with patients as the ultimate beneficiaries.

"Our work and approach fits well with Mayo Clinic's vision of looking after patients first. Genomics is an area of focus that no other myeloma center has sunk its teeth into yet," says Dr. Stewart. "There's excitement in having the team come together to become one of the world's leading centers in multiple myeloma. Now we just have to deliver, and we feel confident we will do so."