Before new tests and treatments can be introduced they need to be tested thoroughly. This is so we can be sure that they work and that they are safe.
Targeted therapies are treatments that act on processes in cancer cells. Many types of targeted 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 targeted therapy.
There is research into specific targeted therapies, including:
- bortezomib (Velcade)
- lenalidomide (Revlimid)
- monoclonal antibodies such as iltuximab
Vaccines are a type of targeted therapy. Myeloma vaccines are designed to try to encourage your own immune system to pick out and attack myeloma cells.
Vaccine treatment for myeloma is very experimental, and is only available as part of a clinical trial.
Radiotherapy has been a treatment for myeloma for some time. The high doses needed to kill myeloma cells affects the rest of the body. This causes side effects. Researchers are looking into how to reduce the effect on healthy cells.
Targeted radiotherapy uses a radioactive cell that is attached to a targeted therapy drug, called a monoclonal antibody. The monoclonal antibody looks specifically for myeloma cells. It carries the radiation to the cancer cells. So they have a high dose of radiation and are killed but there are fewer side effects for the rest of the body.
Chemotherapy is one of the main treatments for myeloma. You usually have it with a targeted cancer drug and steroids. Researchers are looking at combining different drugs and new chemotherapy drugs.
Research is looking at:
- liposomal doxorubicin (Caelyx) with bortezomib (Velcade)
- bendamustine, thalidomide, and bortezomib (Velcade)
CAR T-cell therapy (chimeric antigen receptor T-cell therapy) is a very new type of immunotherapy treatment. It is being looked at in early phase trials and uses your own immune system to treat myeloma.
Researchers remove a certain type of white blood cell, called T cells. These cells are very good at helping fight infections but they aren't so good at telling the difference between a normal cell and a cancer cell. The researchers change the T cells in the laboratory and give them back to you through an infusion. The researchers hope the altered T cells will recognise and attack any myeloma cells.
Stem cell transplants
Intensive treatment is when you have high dose chemotherapy followed by stem cell transplant. Having the stem cells back means that you can have the high dose chemotherapy. It has been a treatment for myeloma for some time. Doctors are researching how to minimise side effects of stem cell transplants. They also want to lengthen the time that people with myeloma are in remission. This is when there is no sign of myeloma when you have tests. They hope that they may be able to eventually cure it.
These are also called tandem transplants. This means having another stem cell transplant or bone marrow transplant about 6 months after your first transplant. The aim is to keep your myeloma in remission for longer. Having 2 transplants increases the risks and side effects. The research is ongoing.
Mini transplants are also called reduced intensity conditioning (RIC) allografts.
Conditioning is the chemotherapy or radiotherapy you have as part of your transplant. An allograft is a transplant from another person. The other person is a matched donor. Your bone marrow must match theirs. A matched donor is often a brother or sister.
With a mini transplant you have a lower dose of chemotherapy or radiotherapy than you would with a standard transplant. You have chemotherapy but not enough to destroy your bone marrow completely. It is enough to stop you reacting to the donor cells. After the chemotherapy you have the stem cell transplant, using your donors stem cells.
You might have an infusion of your donors white blood cells (lymphocytes) if your myeloma doesn't respond, or if it comes back after transplant. This is called donor lymphocyte infusion or DLI.
Research is trying to find out if it is helpful to give extra white blood cells (lymphocytes) after a mini transplant. They want to find out if it helps to keep myeloma in remission for longer and if it reduces side effects including infections and a condition called graft versus host disease (GVHD).
Treating kidney failure
People with myeloma often have kidney problems because of the high levels of protein (immunoglobulin or paraprotein) in their blood.
Some people have kidney failure when they are diagnosed. Blood is usually filtered to remove waste products by a machine. This is called dialysis, and is the standard treatment.
Treatment called plasma exchange (plasmapheresis) may help damaged kidneys to recover. Research is looking to see if plasma exchange, combined with chemotherapy and steroids can improve how the kidneys work in people with myeloma.
Living with myeloma
Research aims to understand how quality of life is affected by different stages of myeloma.
Current research is trying to understand if physical activity affects how people feel physically and psychologically when in remission from myeloma. Researchers are interested in how lifestyle factors affect energy levels, mood and self confidence. It might help to build rehabilitation programmes after myeloma.
Recent research studied the symptoms of advanced myeloma such as pain and tiredness. It aimed to help with new guidelines on follow up for myeloma.