Belantamab mafodotin with pomalidomide and dexamethasone for treating relapsed or refractory multiple myeloma after 1 or more treatments ID6211

Multiple myeloma is a form of cancer that arises from plasma cells (a type of white blood cell) in the bone marrow. Myeloma cells produce large quantities of an abnormal antibody known as paraprotein. Unlike normal antibodies paraprotein has no useful function and lacks the capacity to fight infection.

Myeloma cells suppress the development of normal blood cells that are responsible for fighting infection (white blood cells) carrying oxygen around the body (red blood cells) and blood clotting (platelets). The term multiple myeloma refers to the presence of more than one site of affected bone at the time of diagnosis.

People with multiple myeloma can experience bone pain bone fractures tiredness (due to anaemia) infections hypercalcaemia (too much calcium in the blood) and kidney problems.

Approximately 5000 people are diagnosed with multiple myeloma in England each year (2016 to 2018 data).(1) Five-year prevalence of multiple myeloma in the UK is estimated to be 26 per 100000.(2) It is most frequently diagnosed in older people with about 43% of new cases of multiple myeloma in England in people aged 75-years or older.(1) The 10-year survival rate for people with multiple myeloma in England is estimated to be 29%.(3) The incidence rates are reported to be lower in the Asian ethnic group higher in the Black ethnic group and similar in people of mixed or multiple ethnicity compared with the White ethnic group in England (2013-2017 data).(3)The main aims of therapy are to prolong survival and maintain a good quality of life by controlling the condition and relieving symptoms.

If the condition progresses after initial treatment the choice of subsequent therapy is influenced by previous treatment and response to it duration of remission comorbidities and patient preference.For people whose condition is relapsed or refractory after at least 1 prior line of therapy NICE recommends:• bortezomib monotherapy for people who are at first relapse and who have undergone or are unsuitable for bone marrow transplantation (technology appraisal guidance 129) although this is rarely used in clinical practice.• carfilzomib with dexamethasone for people who have not had bortezomib (technology appraisal guidance 657).• lenalidomide with dexamethasone (technology appraisal guidance 586) and carfilzomib plus lenalidomide plus dexamethasone (technology appraisal guidance 695) for people who had bortezomib.• daratumumab with bortezomib and dexamethasone for people who previously had lenalidomide or when lenalidomide is unsuitable as a second-line treatment (technology appraisal guidance 897).• selinexor with bortezomib and dexamethasone for people whose condition is refractory to both daratumumab and lenalidomide (technology appraisal guidance 974).For people whose condition is relapsed or refractory after at least 2 prior lines of therapies NICE recommends:• lenalidomide with dexamethasone (technology appraisal guidance 171).• panobinostat with bortezomib and dexamethasone for people who had bortezomib and an immunomodulatory agent (technology appraisal guidance 380).• ixazomib with lenalidomide and dexamethasone (technology appraisal guidance 870).• selinexor with bortezomib and dexamethasone for people whose condition is refractory to lenalidomide (technology appraisal guidance 974).For people whose condition is relapsed or refractory after at least 3 prior lines of therapies NICE recommends:• lenalidomide with dexamethasone (technology appraisal guidance 171).• panobinostat with bortezomib and dexamethasone for people who had bortezomib and an immunomodulatory agent (technology appraisal guidance 380).• pomalidomide with low-dose dexamethasone for people who had both lenalidomide and bortezomib (technology appraisal guidance 427).• daratumumab monotherapy for people who had a proteasome inhibitor and an immunomodulator (technology appraisal guidance 783).• ixazomib with lenalidomide and dexamethasone (technology appraisal guidance 870).• isatuximab with pomalidomide and dexamethasone for use within the Cancer Drugs Fund for people who had both lenalidomide and a proteasome inhibitor (technology appraisal guidance 658).For people whose condition is relapsed or refractory after at least 4 prior lines of therapies NICE recommends:• panobinostat with bortezomib and dexamethasone for people who had bortezomib and an immunomodulatory agent (technology appraisal guidance 380).• pomalidomide with low-dose dexamethasone for people who had both lenalidomide and bortezomib (technology appraisal guidance 427).For people whose condition is relapsed or refractory after at least 5 prior lines of therapies NICE recommends:• selinexor with dexamethasone for people whose condition is refractory to at least 2 proteasome inhibitors 2 immunomodulatory agents and an anti-CD38 monoclonal antibody (penta-refractory) and the condition has progressed on the last treatment (technology appraisal guidance 970).References1.

NHS Digital Cancer registration statistics England 2020. Accessed May 2024.2. World Health Organisation International Agency for Research on Cancer (2021) United Kingdom population fact sheet. Accessed May 2024.3. Cancer Research UK. Myeloma statistics. Accessed May 2024