Research into myeloma

Researchers around the world are looking at the causes, diagnosis and treatment of myeloma.

Go to Cancer Research UK’s clinical trials database if you are looking for a trial for myeloma in the UK. You need to talk to your specialist if there are any trials that you think you might be able to take part in.

All cancer treatments must be fully researched before they can be used for everyone. This is so we can be sure that:

• they work
• they work better than the treatments already available
• they are safe

Targeted therapies

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, the most effective combinations, and what the side effects are.

Most research will involve looking at combinations of many of these drugs:

• bortezomib (Velcade)
• lenalidomide (Revlimid) 
• pomalidamide
• carfilzomib
• monoclonal antibodies such as daratumumab,elotuzumab, anti-BCMA antibodies
• panobinostat 
• selinexor
• CAR T-cell therapies
• iberdomide

Immunotherapy

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 first step is for the doctor to remove T cells from your blood. They use a machine called an apheresis machine. This means you have a needle in each arm which connects to the machine.  One of the needles collects your blood which goes through the machine and the other gives you the blood back. When your blood goes through the machine it takes the T cells out.

The researchers change the T cells in the laboratory so they can target myeloma and give them back to you through an infusion. You have a dose of chemotherapy before the 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. The drugs you have before a stem cell transplant is called conditiong. Researchers are looking at different drugs for conditioning, and what the side effects are.Examples of drugs they are looking at include daratumumab and bortezomib.

Double transplant

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 allogeneic transplant

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.The aim is that donor stem cells form a new immune system that attacks myeloma 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.

Living with myeloma

Research aims to understand how quality of life is affected by myeloma and its treatment. Most clinical trials include collecting information about the impact on your quality of life. This is usually means the research team will ask you to answer a questionnaire.

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.