Myeloma, a blood cancer that accounts for 1 in 50 new cancer diagnoses in the UK, is usually treated with a transplant of stem cells from a patient’s own bone marrow. Supported by high-dose chemotherapy, transplants can lead to a disease-free period – but myeloma typically comes back throughout patients’ lives.
A clinical trial, led by the University of Leeds and funded by Stand Up To Cancer, Cancer Research UK and Takeda Oncology, has has tested a treatment in which myeloma relapse patients underwent a second stem cell transplant from their own bone marrow. To suppress cancerous cells after the transplant, doctors used thalidomide, dexamethasone and ixazomib – targeted cancer drugs that are alternatives to chemotherapy. Ixazomib was then used as a longer-term maintenance drug to suppress myeloma cells.
The findings of the UK Myeloma Research Alliance Myeloma XII (ACCoRd) trial, which were published in the Lancet Haematology, show this treatment resulted in extended disease-free survival by seven months compared with regular treatment.
One patient to benefit is Shirley Stewart, 57, whose myeloma returned in 2021:
“Myeloma is a really hard illness, and people often suffer a long time before getting a diagnosis. I was starting to slow down due to ill health, but being on the trial has made a world of difference. I take a tablet every three Fridays a month and on the fourth I have a rest, and it's been suppressing my myeloma cells ever since.
“I can't put it into words what it means to me. It’s given me the chance to see my children through adulthood. The team at the Royal Hallamshire Hospital have been amazing.
“There is the enormity of the realisation that you have been a trailblazer in helping to introduce and contribute something so valuable to science that many lives will benefit from in the future, I’m gladly playing my part in moving science forward.”
Professor John Snowden, co-author of the study, and Honorary Consultant Haematologist at Sheffield Teaching Hospitals NHS Foundation Trust and Professor of Haematology at the University of Sheffield, said:
“It was very special that Sheffield Teaching Hospitals were able to make a major contribution to the recruitment and completion of this important clinical trial, which confirmed benefits for patients with relapsed myeloma by providing them with significantly improved length of remission. We continue to work closely with the Leeds clinical trials team to improve survival and quality of life in patients with myeloma.”
Gordon Cook, Professor of Haematology and Director of the Leeds Cancer Research Centre at the University of Leeds, and Consultant Haematologist at Leeds Teaching Hospitals NHS Trust, said:
"Not only did the ACCoRd trial improve patients’ time free from myeloma, it showed that using these drugs can also improve patients’ quality of life compared to using chemotherapy or long-term steroid use. Smarter, kinder treatments are a key part of the work we’re doing at the Leeds Cancer Research Centre.”
Suppressing myeloma cells
Ixazomib targets myeloma cells by stopping the breakdown of damaged or unwanted proteins. The build-up of proteins becomes toxic to myeloma cells, as they produce higher amounts of proteins than non-cancerous cells. Coupled with a stem cell transplant, this means new, healthy cells can grow while myeloma cells are repressed.
Because ixazomib is not a steroid, it can reduce treatment-associated health problems with metabolism and infections.
The researchers say the results of this trial, known as Myeloma XII or ACCoRd, present an alternative treatment option for patients who are well enough to go through a second bone marrow transplant.
Dr Nisharnthi Duggan, Science Engagement Manager at Cancer Research UK, said:
“It's great that initial results of the ACCoRd trial show that people who received targeted treatment after their stem cell transplant had more time with their loved ones. We're pleased to fund this study investigating potential new treatment options for people with myeloma through our Stand Up To Cancer campaign. We look forward to hearing further results after the final analysis is complete.”
The trial took place across 79 UK hospitals and was funded by Cancer Research UK and Takeda Oncology. The study drug (ixazomib) was provided by Takeda Oncology, and the study is supported by the UK Myeloma Research Alliance. The trial is managed by the Cancer Research UK Clinical Trials Research Unit Leeds (CRUK CTRU) and sponsored by the University of Leeds. The National Institute of Health and Care Research (NIHR) also supported the study through the NIHR Leeds Biomedical Research Centre.
***CREDIT University of Leeds/Mia Saunders & Sheffield Teaching Hospitals/Claudia Blake***