Can We Truly Cure Multiple Myeloma? Experts Say Yes
The Spanish Society of Hematology and Hemotherapy (SEHH) held its ninth 'HematoAvanza' Outreach Conference at the Pazo de San Lorenzo in Santiago, Spain. The event brought together hematologists, patients, science communicators, and journalists to explore key advances in hematologic disorders, with multiple myeloma taking center stage in the discussions.
María Victoria Mateos, MD, PhD, president of the SEHH, stated that 'we are at the point where we can talk about curing patients with myeloma.' Mateos is also the director of the Myeloma Program and Clinical Trials Unit at the Salamanca University Hospital and an associate professor of medicine at the University of Salamanca, Salamanca, Spain.
Paradigm Shift
Until now, multiple myeloma has been considered an incurable disease. However, new treatments, new therapeutic strategies, and early diagnosis are making it possible to achieve a functional and even complete cure in an increasing proportion of patients.
Mateos explained that the definition of cure refers to survival comparable to the average life expectancy for a patient's age and sex at diagnosis, without the need for ongoing treatment.
'I would like to add a nuance,' she said. 'In myeloma, some patients meet this goal, but sometimes without the possibility of discontinuing treatment, which would mean a functional cure or a chronic disease. However, in the end, I think it is realistic to say that in myeloma, we are moving toward survival for many patients, some completely and others functionally,' emphasized Mateos.
The main challenge in managing multiple myeloma is the typical age at diagnosis, which is often older than 65 years. The disease is biologically complex and involves multiple tumor clones that evolve over time. Mateos emphasized that 'a single drug is not enough to control it.'
Therefore, curative efforts should target asymptomatic patients in good overall health and those with newly diagnosed myeloma. Early detection is crucial, especially for identifying high-risk asymptomatic cases.
Mateos also discussed the latest advances in treatment: 'We have innovative drugs, such as bispecific antibodies and CAR [chimeric antigen receptor]-T cells, and increasingly sensitive diagnostic tools.' These strategies demonstrate rapid, profound, and lasting responses, consolidating themselves as pillars in the management of myeloma.
Similarly, the detection of negative minimal residual disease (MRD), a concept on which the Spanish Myeloma Group has worked intensively, has become the main prognostic marker for myeloma. This condition, which indicates the absence of tumor cells measurable with highly sensitive techniques, is considered the primary objective of clinical trials. Mateos noted that 'the absence of measurable residual disease maintained over time is associated with excellent survival rates.'
She further emphasized that the FDA has already approved the concept of 'absence of measurable residual disease' as a primary objective for drug approval, and the European Medicines Agency is in the approval process, which is expected to occur shortly.
'In newly diagnosed active myeloma, we are in a position to cure,' said Mateos.
One of the most relevant studies, the PERSEUS trial, has evaluated the combination of daratumumab, bortezomib, lenalidomide, and dexamethasone , followed by transplant. This strategy has shown a median progression-free survival of 17 years and up to more than 20 years in patients with good prognoses. This could represent an effective cure for a significant number of patients.
Even in patients who are not transplant candidates, the same combinations achieve median progression-free survival rates of 9-11 years, which, in some cases, translates into life expectancies comparable to those of healthy individuals.
With the help of advanced diagnostic tools, doctors can now detect high-risk smoldering multiple myeloma before symptoms appear.
A study by the Spanish Myeloma Group showed that early treatment with lenalidomide can delay progression by up to 7 years. Approximately one third of patients achieved sustained MRD negativity after early lenalidomide treatment.
Mateos emphasized the crucial role of the National Plan for Advanced Therapies in the Spanish National Health System, describing it as 'a key strategy to ensure equitable access to innovative treatments for high-impact hematological cancers.'
In this regard, she highlighted the essential need for a planned update of the National Plan for Advanced Therapies to include measures that accelerate the accreditation of more hospitals capable of administering these treatments, expand the approved indications for cellular therapies in hematological cancers, and establish sustainable financing mechanisms that integrate innovation without creating territorial inequalities.
Mateos expressed satisfaction with the recent expansion of the National Health System's network of advanced therapy centers, welcoming the addition of the University Hospital of Navarra, Pamplona; Vigo Hospital Complex, Vigo; and Miguel Servet Hospital, Zaragoza. These three new centers will join the existing 28, bringing the total number of accredited centers to 31 in Spain.
Future Vision
The immediate future of myeloma treatment focuses on establishing sustained MRD-negative disease as a therapeutic goal and key criterion for new drug approvals. Immunotherapy is also expected to play a growing role, given its ability to induce long-term remission.
Mateos noted that 'pharmaceutical innovation is changing the natural history of myeloma.' A cure for all patients is still out of reach, but many can now expect to live disease-free or with minimal treatment.
With advances in immunotherapy, transplants, early diagnosis, and monitoring, 2025 could be the year when a cure for multiple myeloma becomes a reality for many.
Mateos reported receiving honoraria from speaking engagements and serving on advisory boards of Janssen Pharmaceuticals, Celgene, Takeda Pharmaceuticals, Amgen, GlaxoSmithKline, AbbVie, Pfizer, Regeneron Pharmaceuticals, Roche, Sanofi, Oncopeptides, and Kite Pharma, Inc.
The seminar coverage was partly funded by the SEHH, which covered the travel expenses. The published content is independent and reflects only the views of the author and the management of El Medico Interactivo.
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