Making informed decisions in the event of myeloma relapse

Date published: Sep 09 2020

Treating relapsed myeloma

Around 5,700 people are diagnosed with myeloma in the UK each year. As there is no cure for myeloma, most patients will eventually relapse. For patients that have relapsed, treatment options aim to bring the myeloma back under control.

In patients who are deemed fit enough, initial myeloma treatment involves receiving novel agents combined with chemotherapy and, in some cases, the addition of targeted radiotherapy to destroy as much of the cancer as possible. Patients then undergo a high dose of chemotherapy, followed by a stem cell transplant using the patient’s own stem cells to replace the blood-producing cells that will also have been damaged by the treatment. Following relapse, a second ‘salvage’ stem cell transplant can take place, but no direct evidence of its effectiveness was previously available.

Researchers from the NCRI Haematological Oncology Group and Myeloma Subgroup identified that due to the lack of evidence on the effectiveness of this ‘salvage’ transplant as a treatment, doctors and patients were unable to make informed decisions about their treatment in the event of a relapse. The Myeloma Subgroup set about designing a trial to resolve this unmet need.

Measuring the effectiveness of salvage stem cell transplants – Myeloma X

The group developed the Myeloma X trial, funded by CRUK, to measure the effectiveness of salvage stem cell transplants so that clear, accurate guidelines and treatments can be given in the event of a relapse.

The support that the NCRI Haematological Oncology Group and Myeloma Subgroup offered to the Myeloma X trial was integral to its success, and the benefits that it has brought to patients.

Prof Gordon Cook, the trials chief investigator and the Chair of the NCRI Myeloma Subgroup, and Chair of the UK Myeloma Research Alliance which coordinates the UK myeloma clinical research portfolio for the NCRI, explained that the importance of the groups support: “I received support with Myeloma X from the Group from the outset. There were many bureaucratic issues activating sites and the support of the Group’s membership here was key. Trial recruitment was slow, so the Group’s support was crucial in keeping faith with the trial.”

Providing evidence for the best treatment of myeloma relapse

The research found that there was a clinical and survivorship benefit to salvage transplants – the first (and only) study of its kind to show this. The primary end points were published in The Lancet Oncology.

Prof Gordon Cook said: “The findings are pretty huge. It’s the only global study of its nature in this clinical space, the results have been incorporated into the NHS England Commissioning Policy and NICE Clinical Guidelines and incorporated into the international guidelines (European BMT guidelines, International Myeloma Working Group guidelines). Consequently, the number of salvage transplants for relapsed myeloma has risen.”

Thanks to ambitious aims to improve the evidence base, clinical practice and ultimately the treatments that people with Myeloma receive, the NCRI Myeloma Subgroup and the UK Myeloma Research Alliance were able to support this ground-breaking study that has resulted in clearer clinical guidelines and better, evidence-based treatments for myeloma patients.

Following this study another phase 3 study has begun recruitment. UKMRA Myeloma XII, funded by CRUK, will investigate the durability of response to the second transplant looking at ixazomib, a cancer growth blocker, to see if ixazomib can strengthen the effect of the second stem cell transplant