Monash study identifies new high-risk group in multiple myeloma, allowing clinicians to intervene early to improve patient outcomes

Early treatment response of newly diagnosed multiple myeloma patients should direct future therapy decisions, according to latest research at Monash University.
Myeloma, also known as multiple myeloma (MM), is a cancer of plasma cells (a type of white blood cell).  Each year in Australia around 1700 people are diagnosed with myeloma—the equivalent of four people every day.
Published last week  in the British Journal of Haematology, the collaborative Monash University and Monash Health study has revealed that the way MM patients respond to treatment after just two cycles of bortezomib, a new class of anti-cancer drug, determines outcomes and should guide future treatment decisions.
Lead researcher Monash Health haematologist Dr Pasquale Fedele said the introduction of two classes of medications, the immunomodulatory drugs and the proteasome inhibitors - collectively referred to as the ‘novel agents’, has dramatically improved the outcomes of patients with multiple myeloma. However, clinicians are still learning how best to utilise these medications.
“Although triplet induction regimens administering both novel agents concurrently are widely considered ‘gold standard’, the costs of such protocols are prohibitive for many healthcare systems,” Dr Fedele said.
“Furthermore, combinational therapy may increase the risk of toxicity, and a greater number of patients appear unable to tolerate these more intensive regimens.”
“It is important therefore that we identify which patients actually need this more intensive treatment versus those who are likely to do well with standard regimens”.  
Study co-author Dr George Grigoriadis, a Monash Health haematologist and Monash University researcher said currently it isn’t known whether stratification, based on patients achieving specific milestones early in their treatment, will identify which patients ‘in real time’ are likely to have poor long-term outcomes and therefore may benefit from early escalation of therapy.
The research team conducted a retrospective review of all newly diagnosed MM patients at Monash Health who were treated with bortezomib, a proteasome inhibitor, between 2012 and 2016.
“Our study results demonstrate that patients who fail to respond after two cycles of bortezomib have poorer survival rates compared to those who do, suggesting that this group of patients may benefit from early treatment escalation,” Dr Grigoriadis said.
Importantly however, current prognostication based on cytogenetics and clinical factors at diagnosis does not identify this poor risk group.”
The study authors are now advocating for early stratification to be incorporated into the design of future clinical trials for MM, to determine if directed treatment escalation results in improved outcomes for this vulnerable group of patients.