London (Press Release) – The best way to diagnose, treat and monitor myeloma – a type of blood cancer – has been set out in guidance published today by the National Institute for Health and Care Excellence (NICE). The NICE clin­i­cal guideline aims to help the NHS provide con­sis­tently excellent care for people over the age of 16 in England with myeloma.

Myeloma (also called multiple myeloma) is a relatively rare type of cancer; around 4800 people are diag­nosed with the disease each year in the UK making it the 17th most common type of cancer.

Myeloma is a cancer of plasma cells which are found in the body’s bone marrow. These cells normally produce anti­bodies which help the body to fight illnesses, but myeloma stops these anti­bodies from work­ing properly. A person with myeloma is more sus­cep­tible to in­fec­tions and finds it harder to recover from them. Other symp­toms in­clude pain, bone disease, kidney damage, anaemia and fatigue.

The disease can develop any­where there is bone marrow, so it can affect many dif­fer­en­t bones in­­clud­ing the spine, pelvis, ribs, and the long bones in the arms and legs.

There is no cure for myeloma, but there are treat­ments that can reduce the number of myeloma cells in the body, help with the symp­toms and im­prove quality and length of life. Myeloma is a relapsing-remitting cancer char­ac­ter­ised by periods when symp­toms are present and require treat­ment followed by periods when the disease is under control.

Professor Mark Baker, clin­i­cal practice director for NICE, said: “Although there is no cure for myeloma, several novel drug treat­ments have been licensed in the past 10 years that have led to sub­stan­tial im­prove­ments in the quality and length of time it is possible to live with the disease. However, there is still variation across the country in terms of providing a coherent and con­sis­tent ap­proach to the man­agement of myeloma.

“Myeloma is also a dif­fi­cult con­di­tion to diagnose because many of the symp­toms are non-specific. Our guideline sets out best practice care to ensure people live as normal a life as possible for as long as possible.”

The recom­men­da­tions in the guideline in­clude:

• Communication and support: Offer prompt psychological assessment and support to people with myeloma at diagnosis and, as appropriate, at the beginning and end of each treatment, whenever the disease begins to get worse despite treatment (disease progression) and when people start to require end of life care.
• Laboratory investigations to provide prognostic information: Use the same sample for all diagnostic and prognostic tests on bone marrow, so people only have to have one bone marrow aspirate and trephine biopsy.
• Imaging for people with suspected myeloma: Offer imaging to all people with a plasma cell disorder suspected to be myeloma. Doctors should consider whole-body MRI as the first imaging procedure.
• Service organistion: Each hospital treating people with myeloma should provide regional access through its network to facilities for intensive inpatient chemotherapy or transplantation, renal support, spinal disease management, specialised pain management, therapeutic apheresis, radiotherapy, restorative dentistry and oral surgery, and clinical trials, in particular early phase trials.
• Managing relapsed myeloma: Offer a second autologous stem cell transplant to people with relapsed myeloma who are suitable and who have completed re-induction therapy without disease progression and had a response duration of more than 24 months after their first transplant. A second autologous stem cell transplant should be also considered in people who have had a response duration of between 12 and 24 months after their first transplant.

Professor Curly Morris, Consultant Haematologist and Chair of the guideline committee, said: “The NICE guideline on myeloma will be of benefit to patients and provide clarity for clinicians in a number of areas where, until now, there has been uncertainty. Key recom­men­da­tions in­clude clarifying the number and timing of diagnostic tests per­formed on people with possible myeloma and their radiological assess­ment.

“While drug treat­ment options are largely covered by existing NICE guidance, it has been possible to make a strong recom­men­da­tion in favour of second stem cell trans­plants for suitable patients and also for the best man­agement of pri­mary Plasma Cell Leukaemia, a very aggressive form of myeloma. Additionally there are important recom­men­da­tions for the man­agement of people with myeloma who have bone disease, in­­clud­ing active interventions, man­agement of people with renal disease, pain man­agement and sup­port­ive care especially around thrombosis, in­fec­tion and neu­rop­athy.”

Monica Morris is a Clinical Nurse Specialist and was a member of the guideline committee. She is now Healthcare Professional Programme Manager at Myeloma UK: “This guideline is an important document for the wide range of health­care professionals and specialists involved in the care of myeloma patients. The evi­dence-based recom­men­da­tions not only provide clarity in aspects of myeloma treat­ment and man­agement not covered by existing NICE guidance, but also guide best practice in preventing and managing com­pli­ca­tions and side effects, such as bone disease, pain, fatigue, periph­eral neu­rop­athy and in­fec­tions, all of which can have a huge impact on patients’ quality of life. Importantly the guidelines also recommend the need to provide individualised in­for­ma­tion and sup­port to patients, families and carers at all stages of the path­way, which is particularly relevant for myeloma patients, whose needs and concerns change throughout the course of their disease.”

Alan Chant, patient and carer member of the guideline committee, said: “This guideline rep­re­sents an important step forward for myeloma patients. As well as reinforcing existing best practice, it makes recom­men­da­tions for treat­ment based on evi­dence and the ex­peri­ence of leading clinicians. It should ensure that diag­nosis and treat­ment are standardised throughout the country.

“The guideline is avail­able in a version for patients and carers which summarises the care path­way and suggests questions that they may wish to ask their care team at each stage of their diag­nosis and treat­ment. This is a valuable source of in­for­ma­tion.

“Of particular interest to patients and carers is the in­for­ma­tion and sup­port that should be avail­able to them at each stage of their diag­nosis and treat­ment, together with details on preventing and dealing with poten­tial side effects of the disease and treat­ment - such as periph­eral neu­rop­athy, in­fec­tions and fatigue - which can affect their quality of life.

“Importantly this guideline achieves two objectives. It sets out best practice for clinicians for diagnosing and treating myeloma, and provides knowledge to myeloma patients and carers to under­stand their con­di­tion and treat­ment, ask relevant questions and become better engaged with their care team during the course of their treat­ment.”

The guideline also complements existing NICE guidance on the drug treat­ment of myeloma. It sets out which treat­ments – in­­clud­ing stem cell trans­plants – should be used to man­age the con­di­tion as well as those to prevent and treat bone disease and acute renal disease, which can be caused by the cancer.

NICE has also published a new guideline to help tackle local variation and im­prove survival rates for cancers that affect the airways of the head and neck. In the past decade, UK oral cancer incidence rates have in­­creased by a third and the chance of a person dying has risen by around 10%. The new guideline in­cludes recom­men­da­tions on the best tests to help diagnose these types of cancers earlier, which treat­ments are most suitable at each stage and what in­for­ma­tion should be provided to people throughout their treat­ment.

About the guidance

• The guideline is available at www.nice.org.uk/guidance/ng35.
• The guideline is aimed at commissioners and healthcare professionals in hospitals and other specialist settings specialist hospitals, as well as people with myeloma and their families and carers,
• Myeloma is a cancer of plasma cells which are found in the body’s bone marrow. These cells normally produce antibodies which help the body to fight illnesses, but myeloma stops these antibodies from working properly. A person with myeloma will be more susceptible to infections and is likely to experience symptoms such as pain, bone disease, kidney damage, anaemia and fatigue.

Myeloma facts and figures

• 4,039 people in England were diagnosed with myeloma during 2011.
• Data for England shows that myeloma is almost twice as common in black people as in white and Asian people.
• According to Cancer Research UK, almost 50% of people with myeloma in England and Wales will survive for at least 5 years after diagnosis and 3 in 10 people will survive for 10 years or more.

For more statistics relating to myeloma, visit the Cancer Research UK website.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving im­prove­ment and excellence in the health and social care system. We develop guidance, standards and in­for­ma­tion on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treat­ments, which are based on the most up-to-date evi­dence and provide value for money, in order to reduce inequalities and variation.

Our prod­ucts and resources are produced for the NHS, local author­i­ties, care providers, charities, and anyone who has a responsibility for commissioning or providing health­care, public health or social care services.

To find out more about what we do, visit our website: www.nice.org.uk and follow us on Twitter: @NICEComms.

Source: NICE.