Are We On the Brink of a Cure for Myeloma?
Over the past decade, we have seen an incredible improvement in outcomes for patients with multiple myeloma. As I’ve said before, there’s every reason to believe that myeloma, as a disease, is on the ropes. Thanks to continued advancements in novel therapies and treatment regimens, the five-year survival rate is more than 50% and more patients than ever before are achieving complete responses. These achievements — while great for patients and their families — have led to new controversies in the field over what the best treatments are, when they should be used, and for how long they should be used.
At the heart of these controversies is the fact that we are often treating blindly once a patient achieves a stringent complete response (sCR). Disease is absent as far as we can tell with conventional measurement tools, but we know that these patients can have very different outcomes. We are left without guidance as far as whether or how to use maintenance therapy or whether to consider transplant for each individual patient.
New hope may lie in next-generation sequencing-based minimal residual disease (MRD) assessment technology. This technology can detect myeloma cells at a level as low as one cell per million white blood cells taken from the bone marrow. The ability to measure disease burden with greater sensitivity gives us quantifiable information to follow and analyze, helping us to make important clinical decisions with our patients.
For those patients who are MRD negative following initial treatment or transplant, we might consider whether they should stop maintenance therapy in order to avoid adverse events. We can also monitor these patients on a regular schedule, with the goal of picking up disease resurgence before clinically significant relapse occurs.
For our patients who are MRD positive after initial treatment or transplant, we may no longer think of the next step in their treatment as “maintenance therapy”. For these patients, the MRD results likely indicate that the treatment has not fully eradicated their disease and a change in their therapeutic regimen may be necessary.
We may, in fact, be there already, but, if not, I do believe that the day will come when myeloma is a curable disease for many patients. Tools that allow us to assess response at the deepest level will be crucial to achieving this important goal.
Dr. Wolf is a Clinical Professor and the Director of the Myeloma Program at the University of California, San Francisco. The views expressed here are his own and are not an endorsement of Adaptive or the clonoSEQ® Process.