KUALA LUMPUR, April 2 — A haematologist has recommended a health economics study in Malaysia to analyse the cost-effectiveness of using novel therapies for multiple myeloma at an early stage.
Prof Dr Gan Gin Gin – a professor in internal medicine and clinical haematology who heads the medicine department at Universiti Malaya Medical Centre (UMMC) – cited the dilemma policymakers face in deciding whether to invest in treatment for the rare blood cancer, compared to other diseases that also need attention.
“However, I do agree that it is important to diagnose early and perhaps by providing the best treatment upfront (which may be more costly), the probability of relapse may be lower or delayed, which in turn may possibly translate into being more cost-effective,” Dr Gan told CodeBlue.
“However, it is really important that a proper economic analysis be conducted, specifically in relation to our local setting, to better evaluate if the early addition of novel therapies, or early use of these therapies on first relapse rather than to save it as third or fourth line, will be most cost-effective, or to identify specific groups of patients who may benefit from the novel therapies earlier.”
Dr Gan explained that there are now many treatment options for multiple myeloma that drastically improve survival, but accessibility to novel treatment remains a challenge. Ten-year survival is possible with treatment1.
“Some of these novel agents can be expensive and accessibility may be difficult, especially in the public setting where resources are limited. The other is the availability of some of these novel therapies such as CAR T-cell therapy and bispecific antibodies, where the registration of these therapies may take some time. The lack of facilities or regulations may also pose another obstacle.”
Dr Gan also named a few other challenges to multiple myeloma patients obtaining treatment that aren’t limited to the public sector, including poor awareness of the rare blood cancer among different health care and patients.
“The low index of suspicion may lead to delay in diagnosis. However, the awareness by other specialists is now much better and early referral is usually made,” Dr Gan said.
“The second challenge is the limited accessibility or availability of tests which may help to identify high-risk multiple myeloma and monitoring, for example minimal residual disease. Some of these tests are not cheap and turnaround time may also be long.”
According to the Galen Centre for Health and Social Policy’s policy paper on multiple myeloma, CAR T-cell and bispecific T-cell engager (BITE) therapy for multiple myeloma remain limited due to their high treatment cost and lack of accessibility in resource-limited countries.
“Patients with multiple myeloma are often plagued with multiple relapses due to drug resistance after different lines of treatment. This leads to an unfavourable prognosis,” said the Galen Centre’s policy paper.
The Galen Centre noted that about half of patients with multiple myeloma also suffer from renal impairment that is associated with higher mortality. Most patients with multiple myeloma who require dialysis may be dosed safely post-dialysis.
“Several clinical trials demonstrated that these patient populations benefit from the use of proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies.”
Possible To Control Multiple Myeloma Like Chronic Conditions
Dr Tengku Ahmad Hidayat Tengku K. Aziz – a consultant clinical haematologist and internal medicine physician at Beacon Hospital in Petaling Jaya, Selangor – said it’s possible to survive multiple myeloma and even live with the rare blood cancer with breakthroughs in multiple myeloma treatment.
“What I tell my patients is that multiple myeloma is like a marathon; we’re not running a sprint. We control the disease, like how people survive with diabetes, hypertension, or other chronic diseases,” Dr Tengku Ahmad Hidayat told CodeBlue in a recent interview.
He said the best treatment option for multiple myeloma is a bone marrow transplant, but this is only suitable for young and fit patients, not unfit or elderly people aged 65 years and older who are more likely to get the blood cancer.
Drug therapies are available for multiple myeloma patients who can’t undergo a bone marrow transplant, such as proteasome inhibitors (PIs) or monoclonal antibodies, as well as CAR T-cell therapy and bispecific antibodies.
Dr Tengku Ahmad Hidayat said Malaysia has good access to first-line, second-line, and even third-line treatments for multiple myeloma, but CAR T-cell therapy isn’t widely available here.
“We are on par with many and even advanced countries for the first, second, and third-line treatments; only some clinical trials and compassionate drugs we have not accessed as much as advanced countries or even Singapore.”
The haematologist called for Malaysia to have greater access to clinical trials for innovative drugs and compassionate programmes, where pharmaceutical companies provide drugs approved by regulators in their home countries, like the United States’ Food and Drug Administration (FDA), to Malaysia for free.
Besides the issue of cost of treatment, Dr Tengku Ahmad Hidayat also said there is a lack of haematologists in Malaysia, especially outside urban areas.
“Multiple myeloma is best treated by a haematologist because we are the ones who consider a patient for a bone marrow transplant. This is to ensure that the treatment protocol is followed as much as possible.
“We are also short on haematology centres.”
Multiple myeloma2 affects your plasma cells, which are white blood cells and part of your immune system. Plasma cells make antibodies that help fight infection. Multiple myeloma happens when healthy cells turn into abnormal cells that multiply and produce abnormal antibodies called M proteins. It is this change that starts a cascade of medical issues and conditions.
Multiple myeloma can be more severe than other blood cancers like lymphoma or leukaemia, causing hypercalcemia, renal failure, anaemia, or bone fractures.
References
- Email interview by Boo Su-Lyn with Prof Dr Gan Gin Gin on January 24, 2025.
- Multiple myeloma (2022, May 4). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/6178-multiple-myeloma
