Researchers have found that exercise may be effective at strengthening the immune system in patients with multiple myeloma, providing them with a nonpharmaceutical method of managing the disease, according to new findings presented by Joseph et al at the 2023 ASCO Annual Meeting (Abstract 8060).
Background
Previous studies have shown that the immune system may not function properly in patients with multiple myeloma.
“With these encouraging results from our pilot study, we have been able to show for the first time in patients [with multiple myeloma] that the immune system can be influenced by lifestyle interventions like supervised exercises,” highlighted senior study author Jens Hillengass, MD, PhD, Professor of Oncology and Internal Medicine and Chief of Myeloma at the Roswell Park Comprehensive Cancer Center as well as Professor of Medicine in the Division of Hematology and Oncology at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. “We have therefore started a larger prospective trial offering remote supervised exercise or intermittent fasting to influence parameters such as immune function, bone disease, and [the] microbiome in patients with monoclonal plasma cell disorders,” he added.
When CD4-positive and CD8-positive T cells are exhausted, they become too weak to sustain the attack. While preclinical studies have shown that exercise can reduce immune exhaustion, few studies have examined how exercise can affect biomarkers that measure immune exhaustion in patients with multiple myeloma.
Study Methods and Results
In the new study, the researchers examined two biomarkers of T-cell exhaustion—TIGIT, an immune inhibitory receptor that can reduce the effectiveness of T cells and prevent them from multiplying, and PD-1, which can exhaust T cells and suppress the immune system—in 43 patients who participated in a 6-month exercise regimen. About 50% of the participants received supervised strength training twice per week, while the other 50% of them were unsupervised and received activity trackers with remote prompts to gradually increase their walking.
The participants provided blood samples so that the researchers could measure the ratio of exhausted CD4-positive and CD8-positive T cells that expressed either marker to nonexhausted CD4-positive and CD8-positive T cells as well as compare the change in ratio following the exercise regimen to measurements taken at baseline. Twenty-four participants were reported to have completed the exercise regimen and provided blood samples at the two time points.
After assessing the number of exhausted and nonexhausted T cells in each participant using flow cytometry, the researchers found that the typical participant had a less exhausted T-cell profile after the 6-month exercise regimen compared with at baseline. The ratio of CD4-positive TIGIT-positive T cells to nonexhausted CD4-positive T cells was reduced significantly, from 0.71 to 0.57. Additionally, the ratio of CD8-positive PD-1–positive T cells to nonexhausted CD8-positive T cells was somewhat reduced, from 1.81 to 1.48.
Conclusions
The new findings suggest that physical activity can affect the immune systems of patients with multiple myeloma, creating an environment with fewer exhausted T cells and more robust T cells capable of fighting the cancer.
“We were excited by the outcome of this study, because it suggested that our patients might be able to achieve a less-exhausted immune system through exercise—which comes with many other health and quality-of-life benefits,” emphasized lead study author Janine Joseph, MS, MBA, predoctoral trainee and a senior research specialist in the Department of Cancer Prevention and Control at the Roswell Park Comprehensive Cancer Center. “There’s a lot more work to be done, but we’re hoping this study lays the groundwork for a better understanding of whether exercise should be recommended to patients [with multiple myeloma] to improve their immune function,” she concluded.
The researchers noted that they have begun enrollment for a new clinical trial analyzing non-chemotherapeutic interventions that may improve the immune function and quality of life of patients with multiple myeloma, with a target of recruiting 150 patients.
Disclosure: For full disclosures of the study authors, visit meetings.asco.org.
