The research helping people live longer with multiple myeloma
Canadian researchers and clinical trials are helping turn a once-devastating cancer into a disease many people can live with for years

Not long ago, multiple myeloma was a diagnosis measured in short horizons.

Each year, about 4,300 people in Canada are diagnosed with this cancer of plasma cells in the bone marrow. Myeloma has historically been difficult to treat, with many patients responding to therapy, only for the disease to return. When Dr. Suzanne Trudel began her career in hematology, patients were often living only three to five years. Treatment was largely based on older chemotherapy.

Then, she remembers, new drugs began to arrive.

At a major hematology meeting, Dr. Trudel heard some of the first results for bortezomib, a drug that would help change the field. “There was so much enthusiasm around this new drug and the kind of responses that we were seeing in patients with myeloma,” she says. “We were just at the cusp of all these new treatments coming.”

Today, the story of multiple myeloma is changing again.

Thanks to decades of research, including Canadian-led studies supported by CIHR, many people with myeloma are living longer than ever before. Survival has improved dramatically. For some patients, the disease is increasingly treated as a chronic condition—one that may involve remission, relapse and further treatment, but also years of life that earlier generations of patients may not have had.

“It is incredible,” says Dr. Trudel, a clinician-scientist at the Princess Margaret Cancer Centre. With today’s treatment combinations, some patients may remain in their first remission for 15 to 17 years. “We expect that many patients now… will live to their natural life expectancy.”

That progress has come from understanding why myeloma is so hard to treat. The disease is not a single, uniform target. It can be made up of several related groups of cancer cells, each behaving a little differently. A treatment may work against one group but leave another behind. That is why researchers are studying combinations of therapies that attack the disease in different ways at the same time.

Clinical trials are central to that progress.

One example is the Canadian-led ALGONQUIN study, which tested a three-drug approach for patients whose myeloma had returned after previous therapy. The study helped shape later trials and added to the growing momentum around new options for people living with myeloma. It also raised an important scientific question: Why did some patients respond so well, and for so long?

In samples from patients, Dr. Trudel’s team saw signs that a type of immune cell, called gamma delta T cells, may have been helping the body recognize and control the cancer. Her lab is now exploring whether those immune cells could point the way to new treatments.

Other research aims to make care less invasive. Dr. Trudel and collaborators are studying whether a blood test could one day help monitor myeloma instead of relying so heavily on repeated bone marrow biopsies, which are painful and stressful for patients.

The next wave of trials is equally promising. Researchers are testing immunotherapies—treatments that help the immune system find and attack cancer—earlier in the disease. Dr. Holly Lee, a hematologist and myeloma researcher, points to studies such as MajesTEC-3 and MajesTEC-9, which are exploring how powerful immune-based treatments might be used earlier and more effectively.

But she is careful not to overstate the answer. “I don’t think more is always better necessarily,” she says. Researchers still need to learn how to give these treatments safely, how long to give them and why some cancers eventually find ways around them.

For patients, clinical trials can be both hopeful and demanding.

Rinat Avitzur, a patient partner treated at Princess Margaret, joined a clinical trial after her myeloma relapsed. Within six weeks, she says, her myeloma was “at bay.” She is grateful, but frank about the reality, which includes more tests and more hospital visits.

Still, she says the value of trials is clear. “We rely on clinical trials, not only for best options like mine, but a lot of times as a last resort.”

Her advice to other patients is simple: ask questions, speak up and tell your care team everything. Even symptoms that seem small may matter.

Clinical trials, she says, are how patients gain access to promising options, and how future patients get better care.

That is the quiet promise of health research. One patient’s participation becomes part of a larger story: of scientists, clinicians, funders and families working toward longer remissions, gentler treatments and, one day, cures.

At a glance

Issue

Multiple myeloma is a cancer of plasma cells in the bone marrow. It has historically been difficult to treat because it often returns after therapy and can become resistant to treatment.

Research

Canadian researchers are studying why myeloma responds to some treatments and resists others, while testing new treatment combinations through clinical trials. They are also exploring less invasive ways to monitor the disease, including blood-based tests.