Multiple myeloma develops from cells in the bone marrow. Almost 4,000 cases are diagnosed every year in the UK. There is currently no cure; there are only treatments to stop its progress and relieve symptoms.

NICE's independent experts examined the use of bortezomib for newly diagnosed patients who are eligible for high-dose chemotherapy and who are suitable for bone marrow transplant (haematopoietic stem cell transplantation). The experts were looking at bortezomib in combination with drugs that help to stop the progress of the myeloma: the steroid dexamethasone, or dexamethasone and thalidomide (which cuts the supply of oxygen to the cancerous cells).

Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “We are pleased to recommend bortezomib as a first treatment for people with multiple myeloma before bone marrow transplant. The evidence presented to our independent committee showed that having bortezomib at this stage will help more patients go on to a bone marrow transplant, and consequently prevent the disease from progressing for longer.”

Stem cell transplantation is the gold standard treatment for multiple myeloma because it is associated with improved survival. The aim of induction therapy is to enable more people to have stem cell transplantation successfully. The current standard induction therapy in the UK is the combination of cyclophosphamide, thalidomide and dexamethasone.

Ends

Notes to Editors

About the guidance

1. The committee concluded that although there was uncertainty in the magnitude of overall survival gain associated with bortezomib, it was plausible that bortezomib's impact on induction response could be associated with improved overall survival.
2. The cost of bortezomib is £762.38 per 3.5 mg vial. The average cost of a course of treatment with bortezomib given with dexamethasone is estimated to be £12,260.91 and the average cost of a course of treatment with bortezomib given with dexamethasone and thalidomide is estimated to be £24,840.10.
3. The cost per QALY gained for bortezomib, thalidomide and dexamethasone compared with thalidomide and dexamethasone, and for bortezomib and dexamethasone compared with cyclophosphamide, thalidomide and dexamethasone and compared with vincristine, doxorubicin and dexamethasone, were likely to be below £30,000 per QALY gained and so bortezomib was considered an acceptable use of NHS resources.
4. NICE already recommends bortezomib monotherapy as an option for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation.
5. Thalidomide in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate. Bortezomib (Velcade, Janssen) is also recommended under these circumstances, if the person is unable to tolerate or has contraindications to thalidomide.
6. Lenalidomide in combination with dexamethasone is recommended as a treatment option for people with multiple myeloma who have received two or more prior therapies.

About NICE

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