A Personal Mission: Prerna Mewawalla, MD, on Myeloma’s Transformation

Prerna Mewawalla, MD, did not set out to work in hematology. It was her mother’s multiple myeloma (MM) diagnosis that redirected her career in her final year of medical school. In this inaugural episode of Director’s Cut, a new limited series from The American Journal of Managed Care^® featuring program leaders in hematologic cancer, Mewawalla, director of the stem cell transplant program at Allegheny Health Network and associate professor at Drexel University College of Medicine, reflects on a field she has watched evolve dramatically.

Her decision set her on a path that would take her to the forefront of transplant medicine and, more recently, to the rapidly expanding world of novel immunotherapies for MM. For her, the extraordinary progress in MM treatment over the past 2 decades is difficult to overstate. When her mother was diagnosed, median survival for MM was roughly 3 years, and patients who relapsed after first-line therapy had few meaningful options. Today, this picture looks fundamentally different. Patients are living far longer, supported by a growing arsenal of agents that have been approved across multiple lines of therapy.

Among the most significant developments are bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies, which have reshaped treatment in the relapsed and refractory setting, and for the first time, oncologists are beginning to use the word cure in the context of MM, a term the field had long avoided. Mewawalla anticipates that the immunotherapies now approved in later lines of therapy will continue their migration toward earlier treatment settings. These decisions, still evolving in the relapsed/refractory space, will grow considerably more complex as frontline options expand. Mewawalla entered the field motivated by loss and has spent her career witnessing outcomes improve in ways that would have seemed improbable decades earlier.

“I think it’s a very good time for myeloma,” she says. “It has made tremendous progress, and I think there is only more to come.”