How to achieve prevention and a cure

The opportunities for both prevention and cure are illustrated below:

With recent trials, the goal is to achieve cure by decisive intervention early for smoldering or active myeloma. To evaluate success, it is essential to use sensitive, reliable, and practical testing for minimal residual disease (MRD).

We invite you to learn about the Black Swan Research Initiative® (https://www.myeloma.org/black-swan-research-initiative)(BSRI). Scroll through this page to see how BSRI charts the Road to the Cure.  

The Reality of Cure for Myeloma Patients

For a disease for which recurrent relapse with new disease has been the "norm," the prospect for cure is a tantalizing opportunity. It is helpful to consider cure in three ways.

How do multiple myeloma experts define cure?

Multiple myeloma is unlike other cancers. It can persist for many years in the bone marrow or in the tissues of a patient who is doing extremely well and in an excellent remission without leading to active growth or relapse.

But effective new multiple myeloma therapies are driving longer remissions, and “cure” is coming into focus in three different ways:

• Functional cure is when a patient is in a prolonged remission, but a small amount of myeloma is known to be left, based upon follow-up testing. Such patients are the focus of active research in the BSRI project to understand and enhance immune control of residual myeloma and to prevent the re-growth of myeloma.
   
• Normal relative survival is another way to consider cure. In this case, the myeloma patient is in a prolonged remission and has reached a point where their survival is equal to or better than another person of the same sex and age. In this case, the patient succumbs to "normal" diseases of the elderly such as chronic disease, heart disease, and the like. These concurrent conditions are known as comorbidities. 
   
• True cure is the goal and the most difficult to confirm for sure. No matter how sensitive the testing for MRD, there is always the question that a tiny amount of myeloma is hiding somewhere! From historical analysis, we know that with current testing at a sensitivity level of 10^-6 (one in one million cells of undetected myeloma) persistent remission at this MRD undetected (negative) level for five years. More typically, this translates into very long survival and a cure of some sort. Thus, this is the goal of the BSRI® Cure Trials. Learn more about the CESAR (https://ashpublications.org/blood/article/134/Supplement_1/781/427177/Curative-Strategy-GEM-CESAR-for-High-Risk) and ASCENT (https://clinicaltrials.gov/ct2/show/NCT03289299) trials.

The IMF Global Technology Platform

Through BSRI, the IMF has created the IMF Global Technology Platform to accelerate progress toward achieving a cure.

Research across borders

Thinking Outside of the Box to Conquer Multiple Myeloma

The IMF’s Black Swan Research Initiative® (BSRI) has reshaped how the myeloma community thinks about cure. First led by IMF Co-Founder Brian G.M. Durie, MD (1942–2025), the original BSRI team established a defining principle. This principle is that the only path to curing multiple myeloma is to detect it early and treat it vigorously, before the disease progresses.

By 2019, that vision had moved firmly into practice. The initiative had expanded to more than 50 sites worldwide, where investigators began integrating minimal residual disease (MRD) testing directly into clinical trials. These efforts brought precision measurement into the heart of cure-focused research.

As Dr. Durie once said, “We can talk about the potential for curing myeloma, because we are so close, and we feel that we are, in fact, already most likely curing patients in the cure trials. We have ideas and ways to expand the percentage of patients who are curable, which is just truly remarkable.”

Today, BSRI continues its work with rigor and dedication, coming closer to its final destination on the IMF's Road to a Cure. The illustration here demonstrates how the IMF is attacking myeloma on all fronts:

Scroll Through This Timeline to Learn About IMF Cure-Focused Research

By exploring this timeline, you will gain insights about the IMF's cure trials, including ASCENT, CESAR, and iStopMM.