What are the goals of myeloma treatment? How are overall treatment strategies developed for patients with myeloma with those goals in mind?

What are the goals of treatment?

How are overall treatment strategies developed for patients with myeloma?

As you're facing the decision of embarking on treatment for multiple myeloma and you have those conversations with your doctor, it's important to have a long-term plan.

Initially, there will be a plan that will be developed for the first phase of the treatment, and the goals of those plans should be that we would like to make the patient's life better, because it will become longer, it will be a longer time without the need for therapy, and that we can do so without causing excessive side effects and provide treatments that are accessible for as many patients as possible.

The question we sometimes get is someone might say, which is a common phrase that is used when one thinks about cancer, quality versus quantity.

The good news in myeloma both come together.

So with the better treatments, you will have longer duration of disease control. And quite frequently also improvement in symptoms.

Things like bone pain can improve substantially as you start with your therapy.

I would say it's important for patients who maybe recently diagnosed, and I know it can be overwhelming, but don't be nihilistic. There are very good treatment options. There's good opportunities to put this under control.

And oftentimes this can go on for many years, not only a few, but many, many years.

So, there's opportunities for extended survival with myeloma.

Now, I go back to that long-term plan. The long-term plan involves some basic decisions.

One of the first ones is to say, will stem cell transplant be part of my treatment or not?

For some people, it is usually more of the younger individuals. For some people, we think may not be the best way to go because of the toxicity of transplant, but then also know that it's, remains possible and unfortunately still frequent, that many patients will relapse even after a very successful first line of treatment.

So they have to go through subsequent what we call lines of treatment.

So those are different treatment schemes, that will bring together new agents.

And things are changing all the time.

But as we do that, we consider how the patients do with the previous one usually will switch to something different, try different targets or different mechanism of actions.

And importantly, what that will be three, five and ten years from now.

No one can predict because we're seeing all this very deep research that brings new treatment options for patients who face a relapse.

So what do we think about in terms of the goals for treating multiple myeloma right now?

For most patients, unfortunately, the disease is not curable.

Okay.

And so because of that, what our goal is to do is to try to drive the disease down to the most undetectable level possible.

We want to suppress it as much as we can.

And the reason for that is that when people get to this extremely deep level of remission, we call it, people do well, that disease can stay at a very low level much longer, and it can be controlled for much longer.

And so that often looks like combination therapy up front to try to really reduce that risk burden.

And once the disease is reduced, we can maintain it there with single-agent drugs.

The idea here is that if we can't completely eradicate the disease, we want to make sure we balance the aggressive therapy with more tolerable ones so that we can make sure we maintain quality of life for as long as possible.