Blood Immune Cell Changes in Response to Exercise in Myeloma
Research type
Research Study
Full title
Characterising the effects of exercise on immune cells in blood across the myeloma survivorship continuum
IRAS ID
277825
Contact name
John Campbell
Contact email
Sponsor organisation
University of Bath
ISRCTN Number
ISRCTN10197225
Duration of Study in the UK
1 years, 3 months, 1 days
Research summary
Research Summary
Myeloma:
Myeloma accounts for 10% of all blood cancer diagnoses in the UK and can be broken down into different stages. Patients with early myeloma do not usually have many symptoms and do not require treatment. Patients with myeloma symptoms are treated with chemotherapy followed by a second period of very high-dose chemotherapy with stem cell transplant. After successful treatment, patients are said to be in “myeloma remission”. However, some myeloma cells survive treatment by hiding in areas of the body other than blood and this is called minimal residual disease. Minimal residual disease eventually builds up and myeloma commonly relapses.Physical activity, exercise, and myeloma:
Research has shown that regular physical activity, such as walking regularly in everyday life, can reduce the development of myeloma. There is also evidence that structured exercise training might improve the way cancer treatments work, thought to be driven by changes in the immune system after exercise. Exercise may move immune cells into the blood so that they can find and kill tumour cells. By moving immune cells into the blood where treatments work best, exercise might improve the way treatments work. For these reasons, exercise might benefit myeloma therapy at all stages of disease including, early myeloma (to reduce disease progression), myeloma (to enhance treatments), and myeloma remission (after treatment, to reduce the build-up of minimal residual disease). However, it currently remains unknown if exercise can move immune cells into the blood in people with myeloma.Aims and study design:
This study will investigate if exercise can temporarily increase the number of immune cells in the blood and if exercise can improve the way treatment works against myeloma tumour cells that are grown in a laboratory in three different groups of people with myeloma: pre-treatment, during treatment and after treatment has finished. Participants will be recruited from an active database at the Royal United Hospital, Bath. Participants who take part will complete a 30-minute bout of cycling at the Royal United Hospital or the University of Bath. Blood samples will be taken before, after and 30-minutes after exercise so that we can assess changes in the number of immune cells in the blood and, assess the function of immune cells in the blood combined with treatment against myeloma tumour cells in laboratories at the University of Bath.Summary of Results
16 Patients with smouldering myeloma and 6 patients in multiple myeloma remission following a successful stem cell transplant were recruited for this study. Smouldering myeloma is a 'precancerous' condition that may progress to the blood cancer multiple myeloma. Exercise trials and study measurements took place at the University of Bath, United Kingdom. The first exercise trial consisted of a short cycling session on a stationary upright bike, which got progressively harder every minute. This test was used to determine the fitness status of participants who took part in the study. The second exercise trial consisted of one 30-minute session of cycling on a stationary upright bike at a moderate intensity. This intensity was determined based on the results from the first exercise trial. Of the 16 patients recruited with smouldering myeloma, 9 completed all experimental procedures. Of the 6 patients recruited in multiple myeloma remission, 4 completed all experimental procedures. Patients who did not complete all experimental procedures were excluded following health screening.
We used blood samples collected before exercise, immediately after exercise, and 30-minutes after exercise to examine any changes to the number of immune cells, and the function of immune cells in response to one session of exercise. Immune cell subsets including: natural killer cells, T-cells, and monocytes were significantly increased immediately after one session of exercise and returned to resting levels 30-minutes after exercise, whilst there was no change in the number of myeloma cells (a cancerous plasma cell) in response to exercise. Using experiments set-up in our laboratory we found that the increase in natural killer immune cells and monocytes resulted in a significant improvement to the effects of an immunotherapy drug called daratumumab. Daratumumab is used to treat myeloma and works by harnessing the human body’s immune system (e.g., natural killer cells and monocytes) to eliminate cancer cells in the body. These findings are relevant to patients with multiple myeloma receiving daratumumab therapy because these results show that exercise might benefit this treatment. However, we also found that some of the immune cells that increased during exercise might be targeted accidentally by daratumumab. Therefore, future research should carefully consider the optimal timing, dose, intensity and frequency of exercise in patients with multiple myeloma receiving daratumumab treatment. Further information is available on request by contacting Harrison Collier-Bain (hdcb20@bath.ac.uk).REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
21/EE/0202
Date of REC Opinion
27 Oct 2021
REC opinion
Further Information Favourable Opinion