UK Myeloma Expert Leads Study of New Approach to Detecting and Treating Myeloma Earlier

UK Myeloma expert from Oxford, Professor Karthik Ramasamy, Clinical Director, SACT Clinical Reference Group for GenesisCare, based at their centre in Oxford, is leading the SECURE study, one of several major new trials exploring how myeloma develops and how it could be prevented.

Myeloma – a blood cancer affecting plasma cells in the bone marrow, is currently only treated once it becomes ‘active’. By this point, many people are already experiencing symptoms, such as bone pain, fractures, kidney problems or tiredness.

Smouldering myeloma - an early, pre-cancerous stage of myeloma, doesn’t cause any symptoms, so is often only discovered by chance through routine health checks or blood tests. For decades, people who have been diagnosed with smouldering myeloma, have been advised to ‘watch and wait’ and are given regular check-ups, but have no active treatment - until they develop symptoms.

Factors which may indicate a higher risk of developing symptoms include a greater number of myeloma cells found in the bone marrow, higher levels of paraprotein in the blood, or specific genetic changes detected in the myeloma cells. Within two years of a smouldering myeloma diagnosis, less than 1 in 10 people who are considered lower-risk will develop active myeloma, but the figure is far more elevated for those at higher-risk - where the disease will progress in 50% of cases.

Lead expert Professor Ramasamy says:  “Patients often tell me it’s the waiting that’s hardest. They know there’s something wrong in their blood, but they can’t do anything about it. Our goal is to change that — to move from monitoring to managing.”

The SECURE study (NCT05539079), led by Professor Ramasamy and his team in Oxford, is following hundreds of people with MGUS (monoclonal gammopathy of undetermined significance), a common precursor condition which can develop into smouldering or active myeloma. Over several years, the study will collect blood samples, lifestyle information and quality-of-life data to help doctors understand why some people progress to myeloma and others don’t.

Professor Ramasamy continues:  “We’re learning that myeloma doesn’t suddenly appear — it develops gradually over time. By understanding these early stages, we have a real opportunity to change the outlook for patients and potentially prevent this cancer before it starts.”

We’re building a national picture of early myeloma.  By combining biological data with patient experiences, we hope to develop a more precise way of identifying who needs close monitoring, who might benefit from early treatment, and who can be safely reassured.”

The SECURE study is part of a broader movement of studies in the UK and beyond, including:

• The COSMOS study, led by Professor Kwee Yong at UCLH, investigating the genetic and emotional factors which can drive progression from smouldering myeloma to active disease.
• The MODIFY trial, testing whether early immunotherapy can delay or even prevent myeloma in high-risk patients.
• And in the United States, DARZALEX FASPRO® could soon become the first approved treatment for high-risk smouldering myeloma, after a major clinical trial showed strong results from the AQUILA Phase 3 study, reducing the risk of progression or death by more than 50%.

Professor Ramasamy concludes: “The hope is that in future, people at higher risk of myeloma could receive short courses of preventive therapy or more personalised monitoring, in a similar way to screening programmes for other cancers.

“We’ve seen how early detection saves lives in breast, bowel and cervical cancer,” says Professor Ramasamy. “Myeloma could be next. The more we understand these early stages, the more we can do to stop the disease before it starts.”