The BOTTOM LINE: Early and aggressive treatment has produced excellent results with deep and lasting remissions. Further observation is needed.
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This week's "Ask Dr. Durie" is a common question—a recurring question these days since we have so many new and better therapies being used earlier in the disease course. And the question is, are we starting to cure myeloma? And so, obviously, this is the $64,000 question. Are we curing myeloma? It's possible to say that we are making good progress.
Many of our therapies, particularly for the newly diagnosed or patients who have high-risk smoldering myeloma—the very earliest situation where we would introduce combination therapy—these patients are achieving deep responses to a level of what's called MRD ten to the minus six. And so, this is using sensitive technology to test the bone marrow. And you test 1 million cells and you don't find any myeloma.
So this is called MRD negative at ten to the minus six. We are achieving that with many of these therapies. And so, it's encouraging. Now, after five years of follow-up, which we have for quite a number of these patients with the newer combinations using things like daratumumab, VELCADE, REVLIMID, and dex with or without autologous stem cell transplant.
With this type of combination, patients are continuing to have what we call sustained remissions. After five years, either MRD negative or some with very low levels of minimal residual disease can be detected. And so, quite, quite promising.
The key question is, how long will these remissions last? Well, at five years looks good. We do know from prior therapies that some patients will stay in remission for as long as over 20 years. And so we do know that it's possible to have sustained remissions in myeloma patients.
However, it's just going to take time to see if these new combinations are doing a more complete job and will give remissions lasting five years, Ten years, 15 years, all the way out, and longer.
So, it's hard to be patient, but it's quite secure now that we are seeing very, very promising results.
And so, BOTTOM LINE, for all of those who are anxious, I would encourage you to look carefully at the use of some of these new and promising combinations. We are seeing excellent results, and it may be that some patients will indeed end up being cured and at the very least will be having much, much longer remissions in a minimum of 5 to 10 years, if not longer. So, we can't be secure about saying we're curing myeloma. But indeed the results are very, very promising.
Dr. Brian G.M. Durie (1942-2025) was the co-founder of the IMF. He was a Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels.
