Defining risk in smouldering myeloma (SMM) for early detection of multiple myeloma (COSMOS)

Research summary

Myeloma(MM) is a common bone marrow cancer with over 5,000 patients diagnosed annually in the UK. Patients with MM have cancerous cells in their bone marrow that grow in an uncontrolled fashion and although new treatments have been developed for MM in the last 5 years, it remains an incurable disease, with nearly 3000 deaths yearly. MM is always preceded by defined precursor conditions, known as monoclonal gammopathy of uncertain significance (MGUS) and smouldering myeloma (SMM). However, only 7% of MGUS patients and 50% of SMM patients develop MM over a 5-year period. In the UK, patients are only given anti-MM treatment when the cancer causes damage within the body as the benefit of giving treatment in the pre-cancerous state is uncertain. There is increased understanding that the development of MM occurs due to changes in the cancer’s genetic make-up (genome) and in the cells surrounding the tumour in the bone marrow (immune microenvironment). The cells in the immune microenvironment can support tumour growth and lead to resistance to drugs used to kill MM cells. This project correlates changes in the genetic make-up of the precancerous cells to progression to MM compared to that in the bloodstream and changes that also occur within the cells in the immune microenvironment at the time of disease progression. By identifying which changes in the tumour genome cause the precancerous condition to develop into MM, we can develop a way to risk stratify patients with sMM and treat them according to their risk status. Furthermore, by defining which immune cells are important in helping to drive the conversion of sMM to MM, we can potentially develop new treatments to target not only the tumour cells but also the immune cells helping to drive disease progression.

Principal Investigator

Dr Karthik Ramasamy

Contact us

Email: Latephasehaematology@ouh.nhs.uk

IRAS number

270077