Blood cancers

Upcoming relapsed myeloma guidelines to base decisions on prior response: BSH 2022

New guidelines for relapsed and refractory myeloma due later this year will move away from a “box-ticking” approach and encourage clinicians to make “meaningful clinical decisions”, the British Haematology Society (BSH) 2022 conference has heard.

Outlining the key recommendations, guideline author Dr Matthew Jenner, consultant haematologist at University Hospital Southampton NHS Foundation Trust, said the focus was decision making based on how patients had previously responded to treatments.

The guidelines will also cover the key principles of managing relapsed disease, disease characteristics and when and what to treat, managing side effects and toxicity, decisions around autologous stem cell transplants as well as the importance of patient choice.

“The big difference in relapsed myeloma is you have the benefit of knowing what’s happened before to someone’s disease and in particular in their response and tolerability to treatments,” Dr Jenner said.

“What we’re trying to demonstrate within these relapse guidelines is to really focus on prior treatments and the sensitivity to or indeed the refractoriness to prior treatment rather than specifically focusing … on lines of therapy,” he told delegates.

The guidelines will classify patients into five main groups – those who are sensitive or potentially sensitive to lenalidomide or bortezomib, those refractory to lenalidomide and sensitive or naïve to bortezomib or vice versa, those who are refractory to both and those who have been exposed to three classes of treatment because they have also had a CD38 inhibitor.

Recommendations are also split into preferred options, some of which are not available or funded yet, and some sensible alternatives.

A treatment algorithm that would work for all patients was not an option because someone first diagnosed in 2010 would have had access to different treatment from someone diagnosed in 2015 or 2020, he said.

“It’s simply not possible to map out all of those different scenarios. More importantly we were really keen to move away from that box-ticking type approach that we unfortunately have to follow in myeloma at the moment to empower patients to make meaningful clinical decisions.”

The guidelines would not of course replace multidisciplinary team discussion and would need to take account of clinical features and patient preference, he stressed.

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