Cure for multiple myeloma?

Advances in our knowledge of the pathogenesis of multiple myeloma and the resultant development of novel therapies have significantly improved patient survival during the past two decades. Whether multiple myeloma can be cured, at least in some patients, is increasingly the topic of discussion. Current myeloma treatment strategies may lead to ∼30% “exceptional responders,” who are free of disease progression at ≥ 8 years. Advanced techniques including next-generation sequencing or next-generation flow cytometry detect very low levels of disease. Indeed, achieving minimal residual disease negativity at a sensitivity of 10^–5–10⁻⁶ (1 cell per 100,000/1 million) is a strong surrogate parameter of progression-free and overall survival, far surpassing stringent complete response. Of note, recent data suggest that sustained minimal residual disease negativity more than minimal residual disease negativity at a single timepoint represents a reliable indicator of cure. Ongoing trials explore minimal residual disease-driven risk- and response-adapted treatment strategies as well as novel agents and precision medicine approaches to increase the cure fraction. The present review article defines the term “cure,” discusses methods that help to identify cure, and summarizes therapeutic approaches aimed at finally achieving cure.