Isatuximab in combination for untreated multiple myeloma when a stem cell transplant is unsuitable [ID3981]

Multiple myeloma is a form of cancer that arises from plasma cells (a type of white blood cell) in the bone marrow.

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 (as a result of anaemia) infections hypercalcaemia (too much calcium in the blood) and kidney problems.(1)There were around 5000 newly diagnosed cases of multiple myeloma in England in 2021 mostly in people aged 65-years and over.(2) Multiple myeloma is more common in men than in women and incidence rates are reported to be higher in people of African ethnic group.(3) The 5-year survival rate for adults with multiple myeloma inEngland and Wales is about 56%.(4)Multiple myeloma is an incurable disease and treatment aims to prolong survival and maintain a good quality of life by controlling the disease and relieving symptoms.

High-dose chemotherapy with autologous stem-cell transplantation may be an option for people with multiple myeloma in good general health; however this is an intensive treatment which is not considered appropriate for most people with multiple myeloma.NICE technology appraisal 917 recommends daratumumab with lenalidomide and dexamethasone as an option for untreated multiple myeloma in adults when an autologous stem cell transplant is unsuitable and NICE technology appraisal 587 recommends lenalidomide plus dexamethasone in adults who are not eligible for a stem cell transplant if thalidomide is contraindicated (including for pre-existing conditions that it may aggravate) or the person cannot tolerate thalidomide.NICE technology appraisal guidance 228 recommends thalidomide in combination with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate or bortezomib in combination with an alkylating agent and a corticosteroid if thalidomide is contraindicated or the person cannot tolerate thalidomide.

However thalidomide-based combinations are no longer regularly used in NHS practice as outlined by clinical experts in NICE technology appraisal 917.References:1. Cancer Research UK (2023) Myeloma. Accessed July 20242. NHS Digital (2023) Cancer registration statistics 2021. Accessed July 20243. Cancer Research UK (2023) Myeloma incidence.

Accessed July 20244. NHS Digital (2023) Cancer Survival in England cancers diagnosed 2016 to 2020 followed up to 2021. Accessed July 2024