This page tells you about research into the causes, prevention and treatments of myeloma. You can find the following information
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe.
Firstly, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.
There is research looking into
- Biological therapies – including bortezomib (Velcade), thalidomide, lenalidomide (Revlimid) and vaccines
- Stem cell transplants
- Targeted radiotherapy
You can view and print the quick guides for all the pages in the treating myeloma section.
All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments that are available at the moment
- They are known to be safe
Firstly, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.
Tests in patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.
Our trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. Our database also has information about closed trials and trial results.
All this research is ongoing. Until studies are completed and we are certain that these new treatments really do work better than existing treatments, they cannot be used as standard treatment. If you are interested in taking part in a clinical trial, you need to ask your specialist if you may be suitable for any research studies.
Here is a video on experiences of taking part in a clinical trial:
View a transcript of the video (Opens in a new window)
There are several blood tests that can help to predict how myeloma may develop. You can ask your specialist whether they are helpful in your case. One test is called beta 2 microglobulin. A low level of this protein means that your myeloma is not very active and so is likely to develop more slowly. Another test is called serum albumin – a higher level of this protein is linked to a better outlook. There are other tests, including chromosome tests. Changes to certain chromosomes in myeloma cells can affect outlook. Doctors hope this information will help them with decisions about treatment, such as who needs the most intensive treatment.
Biological therapies are treatments that act on processes in cancer cells. Many types of biological therapy drugs are being tested for myeloma. Some are used as part of standard treatment. Researchers continue to look at these drugs in different combinations and at timings of when is best to use them, as well as studying new types of biological therapy.
You can find details of UK trials looking at biological therapy for myeloma on our clinical trials database.
Biological therapy drugs being used and tested for myeloma include
Doctors use bortezomib (Velcade) for people with myeloma that has come back, or has continued to grow. Bortezomib is also sometimes used with the chemotherapy drug melphalan and a steroid called prednisolone as a first treatment for myeloma.
Bortezomib is a type of biological therapy called a proteasome inhibitor. From research so far, we know that bortezomib with steroids is better at controlling myeloma that has stopped responding to chemotherapy than treatment with the steroid dexamethasone alone. Other studies have shown that people who have bortezomib alongside chemotherapy as the first treatment for myeloma can have a very good response. Myeloma disappears (complete remission) in more people who have bortezomib with chemotherapy than in people who have chemotherapy alone.
The PADIMAC trial is looking at a combination of the drugs bortezomib (Velcade), doxorubicin (Adriamycin) and dexamethasone (PAD) as a first treatment for myeloma. The aim of this trial is to see if people who have a good response to PAD can safely wait until their myeloma comes back to have a stem cell transplant.
Researchers for the BCT trial want to find out if having bortezomib after a stem cell transplant increases the amount of time people are free of myeloma. They also want to find out how bortezomib affects quality of life. Both these trials have closed and we are waiting for the results.
Two new drugs that are similar to bortezomib are being tested in trials around the world - ixazomib (MLN 9708) and oprozomib (OONX 0912). Some trials are looking at ixazomib as maintenance therapy after a stem cell transplant. Maintenance therapy is treatment you take over a long period of time to help keep a disease under control. Doctors are looking at oprozomib in combination with other biological therapies or chemotherapy for newly diagnosed myeloma and myeloma that has come back.
Vemurafenib is a type of biological therapy called a cancer growth blocker. There are many different types of growth factors and they all do different things. Vemurafenib stops cells producing a protein called BRAF, which makes some cells grow and divide. Some cancers make too much BRAF due to a change in the BRAF gene. Doctors already use vemurafenib to treat melanoma skin cancer if the cells have a change to the BRAF gene. The main aim of the VE-BASKET trial is to find out if vemurafenib helps people with other types of cancer, including myeloma, when the cells have a specific change to the BRAF gene. This trial has now closed and we are waiting for the results.
Thalidomide is a drug that affects the chemicals cells use to signal to one another. It can affect all sorts of cell processes, including the growth of cancer cells. Thalidomide is also known as an anti angiogenic drug, which means that it stops tumours from growing new blood vessels. We already know that thalidomide can be very helpful for myeloma that has come back or has stopped responding to other types of treatment.
The MYELOMA 11 trial is comparing thalidomide to another biological therapy drug called lenalidomide when combined with the chemotherapy drug cyclophosphamide and the steroid dexamethasone. It is for people newly diagnosed with myeloma.
The OPTIMAL trial is comparing thalidomide and bortezomib for newly diagnosed myeloma. It is for people whose kidneys are not working well. This is due to the myeloma causing high levels of proteins called free light chains in the blood. These extra proteins can damage the kidneys, as they pass through from the blood into the urine. The researchers want to compare the 2 drugs to see which is better at reducing the number of free light chains in the blood. And to find out if lowering the number of free light chains earlier on helps improve the chances of the kidneys recovering. They also want to learn more about the side effects of these drugs and how they affect quality of life.
Research is also looking at whether thalidomide is helpful as a maintenance treatment. Early research has suggested that people who take thalidomide after high dose therapy may stay free of their myeloma for longer.
Research is going on into similar drugs to thalidomide. Many researchers believe these may end up working better than thalidomide. Lenalidomide (Revlimid) has been shown to work in phase 3 clinical studies of people with myeloma.
Lenalidomide is similar to thalidomide and carries a similar risk of blood clots (deep vein thrombosis or DVT). It also seems to have some different side effects. The most common side effects seen in results from clinical trials are a low white blood cell and platelet count. This can mean an increased risk of infections and bleeding. Research has suggested that there may be an increased risk of a second cancer after using lenalidomide for a long time. But we need more research to confirm whether this is correct.
A phase 3 trial looked at the treatment of myeloma in older people or younger people who couldn't have a stem cell transplant. It compared lenalidomide and dexamethasone to one of the standard treatments (melphalan, prednisone and thalidomide). The trial team found that taking continuous lenalidomide and dexamethasone was a useful treatment for these groups of people. You can read the results for this trial that looked at treatment of myeloma in older people on our clinical trials database.
The LenaRIC trial is a trial funded by Cancer Research UK. It is looking at giving lenalidomide after a stem cell transplant with lower dose chemotherapy using cells from a donor. The lower dose chemotherapy transplant is called reduced intensity conditioning (RIC). The aims of this trial are to see if having lenalidomide after a reduced intensity conditioning transplant is safe and helps to stop myeloma coming back. This trial has closed and we are waiting for the results.
The UK Myeloma 11 trial is comparing lenalidomide to thalidomide. The aim of this trial is to find out how well the combination of lenalidomide, cyclophosphamide and dexamethasone works for people with myeloma.
You may have pomalidomide (Imnovid) if you have myeloma that has come back after treatment with lenalidomide and bortezomib, or your myeloma has become worse whilst on treatment. Pomalidomide is also being looked at in clinical trials.
The STRATUS trial is looking at pomalidomide with dexamethasone to see if it helps people with myeloma who have already had treatment with lenalidomide and bortezomib. This trial has now closed and we are waiting for the results.
Another trial is looking at pomalidomide and dexamethasone in people with myeloma whose kidneys are not working well.
Research is looking into similar drugs to bortezomib (Velcade) for myeloma. One is carfilzomib. Studies have found this drug may be helpful in controlling myeloma that has come back after previous treatments. It doesn't cause the severe tingling and numbness in the fingers and toes (peripheral neuropathy) that can be a side effect of bortezomib (Velcade).
The phase 3 ENDEAVOR trial compared carfilzomib and dexamethasone with bortezomib and dexamethasone for myeloma that had come back (relapsed) or was no longer responding to treatment (refractory myeloma). The researchers found that the average length of time people lived without their myeloma getting worse (progression free survival) was longer for those having carfilzomib. The researchers continue to follow up the people who took part in this trial so that they can find out the average length of time they live (overall survival).
It is not clear yet if a higher or lower dose of carfilzomib is better in treating myeloma. So doctors in America are looking into this at the moment.
The MUK 5 trial is looking at combining carfilzomib with cyclophosphamide chemotherapy and dexamethasone for myeloma that has continued to grow during treatment or has come back after treatment. The researchers want to compare this new combination of treatment with bortezomib, cyclophosphamide and dexamethasone (CVD) to see which is the best combination to use. They also want to find out if continuing with carfilzomib after the initial treatment can stop or delay myeloma coming back.
Part of the Myeloma 11 trial is looking at how well the combination of lenalidomide, cyclophosphamide, carfilzomib and dexamethasone works for myeloma.
Researchers for the CARDAMON trial are looking at carfilzomib and the timing of a stem cell transplant in people with myeloma who have not yet had any treatment.
Monoclonal antibodies (MABs) are drugs that target particular proteins on cancer cells. Siltuximab is a type of monoclonal antibody. It is also called CNTO 328. It blocks the protein called interleukin-6 (IL-6), which may help cancers to grow. If your myeloma does not respond to treatment, or has come back after previous treatment, you may have bortezomib treatment. A trial is looking at whether combining siltuximab with bortezomib works better against myeloma than bortezomib on its own. The trial also aims to find out about the side effects of siltuximab.
Tabalumab is another monoclonal antibody. The JDCG trial is looking at tabalumab alongside bortezomib and dexamethasone for myeloma that has come back after treatment. The researchers want to find out how much tabalumab to give, how well this combination of treatment works and what the side effects are.
Doctors are looking at a new monoclonal antibody called BHQ880 for myeloma in people with poor kidney function. The drug works by blocking a protein called DKK1. This protein stops cells called osteoblasts from forming new bone. This often happens with myeloma and causes bone damage and pain. Blocking the DKK1 protein may allow the osteoblasts to start making new bone again.
Another monoclonal antibody doctors are researching is elotuzumab. The Eloquent 1 trial is looking at giving the drug lenalidomide (Revlimid) and dexamethasone with and without elotuzumab. The trial team want to find out if adding elotuzumab makes the treatment work better.
The trials above have closed and we are waiting for the results.
Studies have shown another monoclonal antibody called daratumumab is helpful in treating people that have had at least 3 previous treatments for myeloma. Trials continue to look at daratumumab in combination with other drugs for newly diagnosed myeloma and myeloma that has come back.
Doctors are using a new type of biological therapy called panobinostat. Panobinostat is also known as LBH589 and it aims to stop cancer growing by blocking enzymes called deacetylases (pronounced dee-as-et-isle-azes). It is a type of deacetylase inhibitor. Cells need these enzymes to grow and divide. Blocking them may stop cancer growing.
A phase 3 trial has shown that it is helpful to add panobinostat to bortezomib and dexamethasone for myeloma that has come back or stopped responding to treatment. You can read the results of the trial looking at panobinostat on our clinical trials database.
The MUK six trial is also looking at panobinostat but alongside bortezomib, thalidomide and dexamethsone for myeloma that has come back or stopped responding to treatment. The researchers want to find the highest safe dose of panobinostat to give alongside the other drugs and to see how helpful this combination of treatment is for myeloma, as well as learning more about the side effects. This trial has now closed and we are waiting for the results.
Another deacetylase inhibitor being researched is vorinostat. It is also called Zolina. A phase 3 clinical trial is looking at giving vorinostat with bortezomib (Velade). The researchers want to find out how well these drugs work together in people who have had a stem cell transplant. The MUK four trial is looking at vorinostat, bortezomib and dexamethasone for myeloma that has come back. This trial has now closed and we are waiting for the results.
The MUK three trial is looking at 2 new cancer growth blockers called CHR-3996 and tosedostat for myeloma that has come back or is not responding to treatment. This trial has now closed and we are waiting for the results.
Perifosine is a drug that works by blocking the signalling pathways needed to keep cells alive. It is also called KRX-0401. Researchers in the USA are looking at how well it works in people with multiple myeloma that is not responding to treatment or has come back after previous treatment.
Vaccine treatment for myeloma is still highly experimental and is only available within clinical trials. As with some other forms of biological therapy, myeloma vaccines are designed to try to encourage your own immune system to pick out and attack myeloma cells. As the immune system is able to remember abnormal cells and recognise them, the idea is that your body would then be protected against the myeloma coming back in the future (a relapse).
Early trials are currently looking into DNA vaccines for myeloma. The vaccine is made from the patient's myeloma cells. The early MMIFTT trial showed that researchers could make and safely give the DNA vaccine, and the immune system did respond. More trials are now needed to see how helpful the DNA vaccine is for people with myeloma.
Cells produce a number of chemical growth factors. Scientists call these chemicals cytokines (pronounced sigh-toe-kines). Cells called stromal cells, found in the tissues that support the bone marrow, make a number of these growth factors. They include substances called interleukin-6 (IL-6), IGF-1, and tumour necrosis factor (TNF alpha). IL-6 stimulates the myeloma cells to make another growth factor called VEGF. Myeloma cells need all these chemicals to grow. IL-6 also plays a part in the destruction of bone by myeloma cells. Research is under way to try and find ways to block these growth factors because that may help to stop the growth of myeloma cells.
Radiotherapy has been used to kill myeloma cells for some time. But one problem has been that the high doses of radiotherapy needed to kill myeloma cells affect the rest of the body too. And this causes unwanted side effects. Targeted radiotherapy means that a radioactive molecule is attached to a monoclonal antibody (MAB) that looks specifically for myeloma cells. The MAB carries the radiation directly to the cancer cells. So the myeloma cells have a high radiation dose and are killed, but there are fewer side effects for the rest of the body.
Researchers have looked at using targeted radiotherapy before a stem cell transplant. They found that the radiolabelled MAB improved the response of myeloma after a stem cell transplant, without any additional side effects. This was a phase 2 trial, so larger trials are now needed. You can read the results of the trial looking at a radiolabelled monoclonal antibody for myeloma on our clinical trials database.
Bendamustine is a chemotherapy drug that has been used for many years for blood cancers. The phase 2 trial called MUK One found that the combination of bendamustine, thalidomide and dexamethasone worked and was well tolerated for people with myeloma that had come back or was resistant to treatment.
Doxorubicin is a chemotherapy drug which is often used to treat myeloma. There is a newer form of doxorubicin called Caelyx (liposomal doxorubicin). Liposomal means that the chemotherapy is held in a fatty covering. This allows it to stay in your blood for longer, and protects healthy cells, so that the chemotherapy causes fewer side effects. Caelyx may sometimes be used with bortezomib (Velcade) to treat myeloma which has progressed or come back. It is for people who have already had at least one treatment, and has had, or is not suitable for, a stem cell transplant.
The ADMYRE trial is looking at a new type of chemotherapy called plitidepsin with dexamethasone for myeloma that has come back or is not responding to treatment. Plitidepsin is also known as Aplidin and it also works like a biological therapy to stop the myeloma making new blood vessels. The study aims to see if plitidepsin and dexamethasone helps people with relapsed or refractory myeloma more than dexamethasone alone. It also wants to learn more about the side effects. This trial has now closed and we are waiting for the results.
You can find out about chemotherapy trials for myeloma on our clinical trials database.
Intensive treatment with high dose chemotherapy followed by stem cell rescue or bone marrow transplant, has been used to treat myeloma for some time. Doctors are continuing to try to improve the results of this type of treatment. It is already getting safer. A few years ago, it wasn't really an option for anyone over 45 because the side effects were too severe. Now doctors are willing to use it for fit patients up to 70 because there are better ways of controlling the side effects.
The doctors researching this treatment also want to lengthen the time that it can keep myeloma in remission. They hope that they may eventually be able to cure it. The latest developments are
Double transplants are also called tandem transplants. This means having another stem cell or bone marrow transplant about 6 months after the first. It is usually another transplant using your own stem cells. This approach may help to keep the myeloma in remission for longer. But having two transplants increases the risks and side effects, so doctors are continuing to research this.
Researchers are also looking into giving a second transplant when myeloma comes back. This is not the same as tandem transplant, which is planned and done before relapse happens.
A trial found that having a second stem cell transplant with your own stem cells helped people to stay free of myeloma for longer than low dose chemotherapy. You can read the results of the Myeloma X Relapse-Intensive trial on our clinical trials database. The trial team are following up the people who took part in the trial to see if there is a difference in the average length of time they live after treatment (overall survival).
Doctors call these transplants reduced intensity conditioning (RIC) allografts. Conditioning means the chemotherapy or radiotherapy treatment you have as part of your transplant. Allograft (or allogeneic) means a transplant from another person.
A mini transplant means you have less intensive treatment than you would as part of a standard donor bone marrow or stem cell transplant. So you have chemotherapy, but not enough to destroy your bone marrow completely. It is enough to stop you reacting to bone marrow or stem cells from a matched donor. A matched donor is a donor whose bone marrow matches yours, and is usually a brother or sister.
The aim of this type of transplant is to get the best chance of a long remission by using stem cells or bone marrow from another person to treat your myeloma. But allografts have more risks and side effects than a transplant using your own cells. So they are not suitable for everyone.
If your myeloma does not respond, or comes back after the transplant, your doctor might suggest treatment with white blood cells (lymphocytes) from your donor. Doctors call this donor lymphocyte infusion or DLI.
Researchers for the PROT4 trial want to find out if it is helpful to give extra lymphocytes a few months after a mini transplant. They want to find out if it helps stop myeloma coming back, affects the number of people who develop a condition called graft versus host disease (GVHD), and if it reduces the chance of getting an infection.
Read about GVHD.
We know from research that people who have a very good response to their initial chemotherapy can stay free of myeloma (be in remission) for a long time, whether or not they have a stem cell transplant. So for these people, it may be better to wait until myeloma comes back before having a transplant.
The PADIMAC trial is a phase 2 trial looking at giving the biological therapy bortezomib (Velcade), the chemotherapy drug adriamycin and a steroid called dexamethasone to people whose myeloma has come back. This combination of drugs is called PAD. The researchers want to know if people who have a good response to PAD can safely wait to have a stem cell transplant. This trial has closed and we are waiting for the results.
Read about stem cell transplants for myeloma.
People with myeloma are prone to kidney problems because of the high levels of protein (immunoglobulin or paraprotein) in their blood. A small number of people have kidney failure when they are diagnosed. At the moment these patients often need dialysis for life. Doctors think that plasma exchange (plasmapheresis) may help damaged kidneys recover. Plasma exchange is a way of removing some of the proteins from the blood using a machine. The MERIT trial is trying to find out if plasma exchange, together with steroids and chemotherapy, will help damaged kidneys recover in people newly diagnosed with myeloma.
The EuLITE study is a European trial for people with multiple myeloma and severe renal failure. Some people have a type of myeloma with light chain proteins in their blood. Light chains are parts of the myeloma protein. The protein can be removed by dialysis if it is damaging the kidneys. The EuLITE study wants to find out if people do better if they have dialysis for a longer time than usual (extended dialysis).
Both of these trials are closed and we are waiting for the results.
A study is looking at the quality of life of people with myeloma. We know from research that having treatment and living with cancer can affect people's quality of life. But only a small amount of this research has been with people with myeloma. The researchers want to develop a questionnaire to assess and measure the quality of life of people at different stages of myeloma. This trial has closed and we are waiting for the results.
Another study is looking at lifestyle and physical health in people who have had treatment for myeloma. It is possible that taking part in physical activity may play an important role in how people feel physically and psychologically when they are in remission from myeloma. In this study, the researchers want to get a better understanding of the relationship between lifestyle and possible improvements in general fitness, energy levels, mood and self confidence. They hope that this information will help them to design better rehabilitation programmes for people who have had treatment for myeloma.
One study has looked at how people cope with the symptoms of advanced myeloma and the side effects of treatment, to see if there is more that could be done to help them. The people who took part in the study had had intensive treatment and now had stable disease. The study team found that symptoms such as pain and tiredness were ongoing problems for people with stable myeloma and significantly affected their quality of life. You can read a summary of the results of this trial on our clinical trials database. The researchers think that the results of this study will help inform future professional guidelines for long term follow up of myeloma patients. But more detailed research is needed.
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