Early treatment shows promise for people at high risk of developing myeloma

The results, published in Nature Medicine, come from a phase 2 clinical trial involving people with high-risk smouldering multiple myeloma.

Smouldering myeloma is an inactive form of myeloma that doesn’t cause any symptoms or harm. Not everyone with smouldering myeloma will develop active myeloma. However, some people are considered at higher risk of their condition progressing.

Researchers investigated whether treating people with high-risk smouldering myeloma earlier, before they developed active myeloma, could reduce the amount of cancer cells by a significant amount and delay the disease progressing.

The ImmunoPRISM clinical trial compared teclistamab with the drugs lenalidomide and dexamethasone.

Teclistamab is a type of immunotherapy called a bispecific antibody. It works by bringing immune cells called T cells into close contact with myeloma cells, helping the immune system recognise and destroy them.

In total, 59 people received treatment in the study. Of these, 45 received teclistamab and 14 received lenalidomide and dexamethasone.

Researchers found that 78% of people treated with teclistamab had a complete response – meaning tests could no longer find the usual signs of their condition. None of the people receiving lenalidomide and dexamethasone had a complete response.

Researchers also looked for minimal residual disease (MRD), which uses highly sensitive tests to look for very small numbers of abnormal cells that may remain after treatment. Around 82% of people treated with teclistamab became MRD negative at the level tested, meaning these tests could not detect remaining disease.

After two years, 92% of people who received teclistamab hadn’t progressed to myeloma, compared with 49% of those who received lenalidomide and dexamethasone.

Traditionally, people with smouldering myeloma have been closely monitored, with treatment beginning if their condition develops into active myeloma. These results suggest that using this new immunotherapy early – while the amount of abnormal cells is relatively low and the immune system is still functioning – could reduce cancer cells significantly.

The results are promising, however it’s important to note that this is an early-stage study involving a relatively small number of people.

Further research will be needed to understand which people with smouldering myeloma are most likely to benefit from which treatment, and to balance the potential benefits of intervening earlier against side effects and the burden of treatment.

For people currently living with smouldering myeloma, these findings do not mean that their treatment or monitoring will automatically change.

Dr Richard Francis, Associate Director of Research at Blood Cancer UK said: “These are exciting early results which suggest that harnessing the immune system with novel immunotherapy before myeloma has fully developed has the potential to considerably delay the disease progressing in people at particularly high risk.

“What is especially encouraging is the significant reduction in cancer cells researchers saw. But this was a small, early-stage trial, and we need longer follow-up and larger studies before we know whether this is an effective long term approach to delay or even prevent people developing active myeloma.

“For people living with smouldering myeloma now, it’s important to remember that these findings don’t immediately change how the condition is managed. Anyone worried about what these results might mean for them should speak to their healthcare team.”