Myeloma: road map towards the cure
María-Victoria Mateos
Centro de Investigación del Cáncer, Hospital Universitario de Salamanca
Most of the manuscripts focused on Multiple Myeloma (MM) starts reading “Myeloma is an incurable disease”. Ravij et al. compared in 2018 the overall and expected overall survival (OS) of young patients with MM and it was markedly worse compared to the general population, in contrast to what it was reported in patients with other hematological diseases like follicular lymphoma, diffuse large B-cell lymphoma and Hodgkin lymphoma.
However, the introduction of several novel therapies, such as proteasome inhibitors (PIs), immunomodulatory drugs (IMiD’s) and monoclonal antibodies (mAbs), high-dose melphalan followed by autologous stem cell transplantation (HDM-ASCT) and strategies to maintain the response, as well as novel immunotherapy strategies including the cell therapy, are challenging the dogma of MM as incurable.
The two main issues for this challenge are: i) MM usually affects to the elderly population and we cannot modify this feature so we have to put the efforts for achieving the cure in young and newly diagnosed patients with MM or asymptomatic MM; and ii) the treatment until now is usually planned as continuous therapy but cure means disease and treatment-free so we have to move towards response and risk-adapted therapies. In addition, it is also necessary to evaluate the treatment efficacy with the most sensitive techniques available to evaluate the sustained absence of residual disease inside and outside of the bone marrow as surrogates for cure (MRD-ve).