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IMS 2026, Part 2: What Does It Mean to be Cured of Myeloma?
For years, multiple myeloma has been considered treatable but not curable. As treatments improve and some patients experience deep, long-lasting remissions, researchers are beginning to ask a new question: What does it mean to be cured of myeloma?
At this year’s Annual IMS Meeting, experts explored this question alongside another important challenge: How can we get more patients, no matter where they are in their myeloma journey, to experience these deep, lasting responses? Studies examined both how to determine when treatment may no longer be needed and whether bringing powerful newer therapies into earlier stages of myeloma could improve outcomes.
How close are we to a cure?
One potential piece of the puzzle is MRD testing, which can detect very small numbers of myeloma cells that may remain after treatment. Several studies presented at IMS explored whether MRD testing could help identify patients who may be able to safely stop treatment and remain myeloma-free for years—an important step toward understanding when, and for whom, a cure may be possible.
Some patients may have an especially low risk of their myeloma returning after treatment ends.
Researchers followed 421 patients who had remained MRD-negative and showed no signs of myeloma on imaging for at least 2 years. They identified an “ultra-low-risk” group of patients who had standard-risk genetics, ISS stage I or II*, and MRD negativity confirmed by a highly sensitive next-generation sequencing (NGS) test.
Overall, only about 7% of these patients had relapsed by 8 years. Among those who stopped treatment, only 3% relapsed within 5 years. These findings suggest that combining sustained MRD negativity with other disease features may help identify patients who have a very low risk of relapse after stopping treatment.
How long does maintenance therapy need to continue?
Researchers explored whether MRD testing could help determine how long patients need maintenance therapy with Revlimid + dexamethasone, with or without Ninlaro. Patients who were MRD-negative after 2 years stopped maintenance therapy. After nearly 10 years of follow-up, patients who were MRD-negative and stopped maintenance continued to do well: the median time before their myeloma progressed had still not been reached, and about half were still alive and progression-free 7 years after stopping maintenance treatment. These findings suggest that MRD testing may help identify patients who can stop maintenance therapy and remain progression-free for many years.
Researchers are learning more about how maintenance therapy can help sustain deep responses.
A third study looked at whether a set period of Darzalex® maintenance could help patients stay MRD-negative and remain progression-free longer. Patients received Darzalex maintenance every 8 weeks for up to 2 years or were monitored without maintenance treatment. More patients who received Darzalex remained MRD-negative over time. Patients who remained MRD-negative for 5 years were also more likely to go longer without their myeloma progressing.
MRD access is limited.
While MRD testing has shown it is an effective way to measure treatment response, is not available to every patient, and researchers are still determining how best to use MRD results to guide care. For now, treatment decisions should not be based on MRD status alone, but should take into consideration risk, patient health and medical history, and response to previous treatments.
*ISS (International Staging System) is a way of classifying myeloma based on blood test results; stages I and II are associated with a more favorable prognosis than stage III.
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