MUK Nine b Trial

Establishing the environment for UK multi-centre clinical evaluation of whole-body (WB) MRI as a diagnostic and treatment response marker in MULTIPLE MYELOMA

Whole-body magnetic resonance imaging (WB-MRI) is the most sensitive imaging test for diagnosis of myeloma bone marrow involvement and is recommended in the UK as the first line imaging test in patients with suspected myeloma

The International Myeloma Working Group and the National Institute for Clinical Excellence in the United Kingdom have published The Myeloma Response Assessment and Diagnosis System (MY-RADS) guidelines to promote the standardization of WB-MRI diagnosis of myeloma and treatment response assessment. 1

However, WB-MRI quantitative measurements have not been prospectively validated or employed in studies guiding myeloma patient management. Furthermore, WB-MRI is currently limited to a few expert UK centres i.e. University College London and The Institute for Cancer Research, London due to technical and educational challenges limiting widespread adoption.

The NCITA Exemplar 3 study (MUK Nine b: OPTIMUM Treatment Protocol) Identifier: NCT03188172 will expand the availability of WB-MRI for multiple myeloma at all major NCITA host institutions and their affiliated major district general hospitals, with the support of the NCITA Trials Unit and QA/QC Unit. The NCITA infrastructure will enable the establishment of standardised WB-MRI protocols and training for standardised data collection, anonymisation, image processing and safe data transfer between host institutions.

This study will provide the data required to apply for further funding to perform a powered multicentre clinical evaluation study in patients with multiple myeloma using WB-MRI.

Inverted greyscale whole body MR image in a patient with multiple myeloma showing multiple sites of disease appearing as dark areas across the skeleton. Whole body MRI has exquisite sensitivity for detecting both larger foci of disease (red arrows), as well as smaller lesions less than 5 mm in size (blue arrowheads), thus improving disease detection and enhancing management decisions.