Genetic Tests May Predict Return of Blood Cancer

Published: 13 October 2025. The English Chronicle Desk. The English Chronicle Online.

Genetic testing could soon offer patients with multiple myeloma a clearer understanding of whether their disease is likely to return within 18 months, researchers have revealed. A new study suggests that combining traditional DNA analysis with RNA gene expression tests can identify “hidden risks” that conventional methods may miss, potentially transforming how doctors predict and treat this complex blood cancer.

Multiple myeloma occurs when the bone marrow produces abnormal white blood cells, known as plasma cells, which crowd out healthy cells and disrupt normal blood function. This leads to a range of debilitating symptoms, including bone pain, headaches, fatigue, and muscle weakness. In the UK, approximately 33,000 people are living with multiple myeloma, and around 6,300 new cases are diagnosed each year.

Although treatments can place the disease into remission, multiple myeloma is considered incurable. Many patients experience relapse, often within 18 months of receiving treatment, leaving clinicians seeking more precise methods to identify which individuals are most at risk of early recurrence.

Researchers at the Institute of Cancer Research (ICR) in London have been exploring the benefits of combining DNA profiling, which identifies mutations in myeloma cells, with RNA-based gene expression tests that reveal how active certain genes are. Both approaches rely on bone marrow samples, but while DNA testing provides a snapshot of genetic alterations, RNA testing can detect subtle changes in gene activity that may indicate aggressive disease behaviour.

Professor Martin Kaiser, a consultant haematologist at The Royal Marsden NHS Foundation Trust and a molecular haematology expert at ICR, explained the challenge. “Multiple myeloma is a very complex disease,” he said. “While current treatments work very well for many patients, there are others who do not respond adequately and may relapse early. Some patients experience early relapse even though they do not show any known high-risk signs at diagnosis.”

The study, published in the journal Blood, evaluated data from 135 patients enrolled in the MyelomaXI clinical trial. Each participant underwent the same treatment regimen alongside comprehensive genetic testing. Over a seven-year follow-up, researchers found that 18.5 per cent of patients experienced a relapse within 18 months of receiving a stem cell transplant. When DNA and RNA test results were combined, 84 per cent of these early relapses could have been predicted.

“This demonstrates that RNA-based testing can uncover risks that DNA tests alone may miss,” Professor Kaiser noted. “By combining these methods, we can change how we diagnose and manage the disease, allowing for personalised care and earlier interventions for patients most at risk.”

Professor Kristian Helin, chief executive of the ICR, emphasised the potential impact of the research on the UK’s healthcare system. “Early relapse affects thousands of patients in the UK every year,” he said. “By combining DNA and RNA testing, our researchers have developed a far more accurate way of predicting early relapse in this disease. This is a powerful example of precision diagnostics transforming patient care. It also ensures healthcare resources are used more effectively, delivering the right treatment to the right patients at the right time.”

Blood cancer charities have also welcomed the findings. Shelagh McKinlay, director of research and advocacy at Myeloma UK, which helped fund the study, described the research as “a major step forward” for personalised treatment. “By pinpointing which patients are most likely to relapse and stop responding to currently available drugs, we can improve the lives of thousands of people affected by this incurable cancer. Prof Kaiser’s work brings us closer to truly individualised care for patients with multiple myeloma, and we are proud to support this research.”

The implications for patient care are significant. Traditional methods of monitoring multiple myeloma focus on established high-risk markers and general blood tests, which may not detect subtle genetic or molecular changes signalling an impending relapse. Incorporating RNA-based gene expression profiling allows clinicians to monitor how the cancer is behaving at a molecular level, potentially providing an early warning system and guiding treatment decisions before the disease progresses.

Starting in 2026, The Royal Marsden Hospital in London will become the first centre in the UK to offer this gene expression profiling test to multiple myeloma patients. The hospital aims to combine this with conventional DNA testing to create a more accurate risk assessment, enabling clinicians to tailor treatment strategies, adjust therapy intensity, and offer additional interventions to those identified as high risk.

Professor Kaiser highlighted that this approach could also improve research outcomes. “Understanding the molecular behaviour of cancer cells gives us insights into which therapies are most likely to succeed for specific patients,” he said. “It is not just about predicting relapse but also about guiding personalised treatment choices to achieve better long-term outcomes.”

The integration of RNA testing with traditional methods represents a step towards precision medicine in haematology, an approach that aims to customise healthcare based on individual variability in genes, environment, and lifestyle. For patients with multiple myeloma, this could mean more effective treatment regimens, reduced side effects, and ultimately improved survival rates.

Experts emphasise that while the findings are promising, wider implementation will require training, infrastructure, and collaboration across cancer centres. Bone marrow sampling, genetic sequencing, and RNA profiling demand specialised equipment and expertise, and ensuring equitable access across the NHS will be a key challenge. Nevertheless, the potential benefits of early detection of relapse could be transformative for both patients and healthcare providers.

Beyond predicting relapse, the research also offers hope for more proactive disease management. By identifying high-risk patients before symptoms worsen, clinicians can monitor these individuals more closely, adjust medications, or offer novel therapies as they become available. This proactive approach contrasts with the traditional reactive model, where interventions are often initiated only after a patient shows clinical signs of disease recurrence.

Multiple myeloma patients and advocacy groups have expressed cautious optimism. Emma Jenkins, a patient advocate diagnosed with myeloma in 2021, said: “Knowing whether my disease is likely to come back soon could help me and my doctors make better decisions about my treatment. It gives a sense of control in a situation that often feels very uncertain.”

While the disease remains incurable, advances like these represent meaningful progress in extending remission periods, improving quality of life, and reducing the emotional and physical burden of relapse. Precision diagnostics, combining DNA and RNA insights, offer a window into the disease that was previously unavailable, providing hope for thousands of patients and their families across the UK.

Professor Helin concluded: “The integration of these advanced genetic tests into routine care is a landmark achievement. It exemplifies how research, when combined with clinical expertise, can directly improve patient outcomes and transform the landscape of cancer treatment. We hope that in the coming years, this approach will become the standard of care for multiple myeloma patients, not just in the UK but globally.”

As research continues, the medical community remains committed to refining these diagnostic tools and expanding their use. The adoption of gene expression profiling marks a new era in personalised oncology, where the behaviour of cancer at the molecular level can inform tailored, timely, and potentially life-saving interventions.