- Cure definition presented at the International Myeloma Society Annual Meeting requires five years off myeloma treatment with no detectable disease
Glasgow, Scotland: Global myeloma experts today presented a consensus definition of cure for multiple myeloma. Nikhil C. Munshi, MD, unveiled the definition at the International Myeloma Society (IMS) 23rd Annual Meeting on behalf of IMS and the International Myeloma Working Group (IMWG).
Myeloma was fatal when it was first described in 1844 and has been considered incurable for most of its history. Advances in treatment are changing that. As some patients remain free of detectable disease for years without treatment, the field needs a clear standard for when remission can be called a cure.
“For many years, multiple myeloma has been described as treatable but not curable. Today, scientific advances have brought us closer to defining what cure means,” said Dr. Munshi. “The depth and durability of responses we are now seeing, along with major progress in MRD testing and modern therapies, have moved the field to a point where we can see that cure exists, and examine how it should be defined.”
Under the new consensus definition, a patient with newly diagnosed or relapsed myeloma may be considered cured after five years in complete remission without any myeloma treatment. Those five years are counted from when treatment ends, regardless of how long the patient was disease-free while still on treatment. The definition also requires:
- At least four measurable residual disease (MRD) tests must be negative, including one at the five-year mark, with no positive result in between.
- The tests must use next-generation sequencing or next-generation flow sensitive enough to detect one myeloma cell among one million cells.
- Advanced imaging, using PET/CT or diffusion-weighted whole-body MRI, must show no disease at the start and end of the period, with no positive scan in between if additional scans are performed.
The off-treatment requirement helps distinguish a lasting response from disease being held in check by ongoing drugs. The five-year window reflects data suggesting that relapse becomes substantially less likely after patients have remained off treatment for that long, although late relapse is still possible. In several other cancers, including Hodgkin lymphoma and testicular cancer, relapse after five years in remission is also uncommon.
Long-term studies discussed by Dr. Munshi estimate that the proportion of patients who may have been cured ranges from 5% to 30% across different groups treated with older therapies. The estimates vary by treatment, age and disease risk. Today’s therapies could improve those outcomes, but more follow-up is needed to know by how much.
In one study, 32 of 97 patients with heavily pretreated myeloma were alive and progression-free at least five years after a single CAR T-cell therapy infusion, without maintenance treatment. The new definition will help determine which long-term responses meet the full criteria for cure.
“We are no longer debating whether cure is possible,” Dr. Munshi added. “We are defining it rigorously, measuring it precisely, and expanding the number of patients who can achieve it — with clarity, discipline, and real hope.”
Dr. Munshi is a founding member and immediate past president of IMS. He is a professor of medicine at Harvard Medical School, Kraft Family Chair, and director of basic and correlative science at Dana-Farber Cancer Institute’s Jerome Lipper Multiple Myeloma Center.
The definition builds on work by international researchers, clinicians and patient advocates at the IMS Myeloma Cure Summit earlier this year.
The announcement comes as nearly 4,000 researchers and clinicians from over 75 countries gather for the IMS Annual Meeting, Sept. 23–26 at the Scottish Event Campus in Glasgow. The program includes more than 635 research abstracts and 35 late-breaking presentations covering new immunotherapies, earlier treatment approaches and advances in monitoring myeloma.
