​Multiple myeloma remains an incurable blood cancer and further improvement in outcomes is needed.   Every year about 100 new patients are diagnosed with multiple myeloma in Singapore. Even with the current gold standard treatment, up to 50 per cent of patients with “high-risk” multiple myeloma experience relapse of disease in less than three years.   “High-risk” in multiple myeloma is when certain chromosome changes are seen at time of diagnosis of multiple myeloma or if patients present with advanced stage of multiple myeloma.

Current treatment regimen for myeloma patients may include a combination of targeted therapy, steroids, with or without chemotherapy, followed by an autologous stem cell transplant, if they are fit to receive bone marrow transplant.   Patients who are not fit to receive bone marrow transplantation receive only chemotherapy.   However, this regimen does not work as well for patients with “high-risk” myeloma, in terms of prolonging survival and slowing the progression of the disease.

A team of haematologists from the Singapore General Hospital (SGH) and National University Cancer Institute, Singapore (NCIS) launched a clinical trial recently to study the efficacy of using a different drug combination to treat high-risk myeloma patients.   The combination includes carfilzomib, a targeted therapy drug that has been approved by the U.S. Food and Drug Administration but currently not available in Singapore commercially.

“The outlook for multiple myeloma patients has improved tremendously in the past decade with the introduction of targeted therapy but 5-year survival for high-risk myeloma patients remains at less than 30 per cent,” said Dr Sathish Kumar, Consultant, Department of Haematology, SGH, who is also Principal Investigator of the study.

In this study, 30 newly diagnosed high-risk myeloma patients who are eligible for stem cell transplant will go through a maximum of eight treatment cycles and bone marrow transplantation. Following this, patients will undergo bone marrow biopsy to assess response and also to evaluate the load of low level “residual” cancer cells. Low level “residual” cancer cells are a major cause for relapse but its volume is also an indication of whether the treatment has been effective.

Measuring very low level of cancer cells in deciding treatment of multiple myeloma is a very new concept and these tests will be done by National University Hospital.   Depending on the results from all these tests, further treatment is decided. Patients who have no evidence of residual cancer cells may stop treatment and start monitoring, whereas patients with residual cancer cells will be offered further treatment.

This will be one of the first study worldwide to use new technologies in an effort to improve outcomes of newly diagnosed “high-risk” multiple myeloma in a clinical study setting, said Associate Professor Chng Wee Joo, Director and Senior Consultant, NCIS and co-investigator of the study.