Protocols for treating Multiple Myeloma (FOI)

Request

Please can you provide the following:

A

The current protocol for treating Multiple Myeloma

B

List of approved medicine on formulary

C

Process to add medicine on formulary and contact details

D

Funding route of medicines for Multiple myeloma

Response

A

Multiple myeloma (MM) or Plasma cell Myeloma and related plasma cell dyscrasias are all undergoing diagnosis and treatment when and as required at Jersey General Hospital. Links with relevant centres in the UK are in place for tertiary care for cases requiring this.

This group of disorders is complex and comprises several entities including relapsed or refractory diseases requiring a range of interventions from careful monitoring to treatment followed by autologous stem cell transplant (in transplant eligible patients) or maintenance (non-transplant eligible patients or post transplantation) when remission is achieved. The diagnosis and treatment of these diseases requires a multidisciplinary approach involving haematological, radiological / imaging, dental, cardiology, physio and chemotherapy expertise available in Jersey.

All protocols used internationally for the treatment of MM are available and can be administered in Jersey according to patient need. These include novel treatments for the disease biologicals and targeted therapies such as ixasomib and daratumumab (even the very recently approved subcutaneous form).

The individual protocol employed for a patient requiring treatment for MM is to an extent individualised mainly based on their assessment at the time of diagnosis or relapse and includes, symptoms, the stage of the disease, comorbidities, vulnerability and transplant eligibility. All therapeutic protocols used combine anti-myeloma combination therapy and supportive therapy (bone strengthening and prevention of infections or erythrocytosis stimulating agents (as required).

The availability of novel agents for the treatment for relapsed refractory disease required until recently the completion of Individual Funding Request (IFR), however, under the new HCS structure, an application for Cancer Drug Funding equivalent process in Jersey is in good progress and includes molecular diagnostics for implementation of targeted therapies.

In addition within HCS we offer internationally recognised state of the art maintenance post autologous stem cell transplant and post remission with lenalidomide which is not available in the UK for public patients. Maintenance treatment is proven to significantly extend disease free survival in patients with multiple myeloma.

B

The Hospital formulary is publicly available on www.gov.je in the following link. Therefore Article 23 of the Freedom of Information (Jersey) Law 2011 has been applied:

Jersey General Hospital formulary

C

An application is required from a Consultant which is then considered by the Drugs and Therapeutics Committee. Consultants can access the application form on the HCS Intranet pages. Only applications from Consultant medical staff are considered.

D

All approved medicines used within the hospital are funded from HCS budgets.

Article applied

Article 23: Information accessible to applicant by other means

(1) Information is absolutely exempt information if it is reasonably available to the applicant, otherwise than under this law, whether or not free of charge.

(2) A scheduled public authority that refuses an application for the information on this ground must make reasonable efforts to inform the applicant where the applicant may obtain the information