Is there a cure for multiple myeloma? How long will I live with multiple myeloma?

Is there a cure for Multiple Myeloma? Recently I had an opportunity to talk about, is it time to talk about cure in myeloma or is there a cure in myeloma? I'm very passionate about this particular topic. I'd say yes, there is a cure for myeloma at this time. Now let me break it down so that you can understand why I'm passionate about it.

First of all, why do we need a definition for cure in myeloma patient? You know, from a patient perspective, when you say multiple myeloma is now a curable cancer, it completely changes how they feel about the disease. Instead of being told that you are inflicted with a chronic disease which is not curable, the term "chronic" doesn't make me feel better. "Oh, we can control the cancer but not cure it." When you say, "I can control the cancer" as a patient, it makes me even wonder or worry more. "That means I have to be on treatment, chemotherapy, lifelong. Oh my god." So that doesn't... so I want it important that there is a hope for the patient and I will tell you why there is hope. Hope for the patient to say yes, myeloma is a curable cancer. This is important for patients to know.

Second, physicians. When a physician is told and understands myeloma is curable now, his approach to the patient, even his body language, is completely different when he approaches the patient because he knows now he can cure this patient. Secondly, he keeps up with the latest development because it is rapidly evolving. New options are coming which are making cure a possibility in myeloma, so he keeps up with it, and he is ready to refer the patient to the latest clinical trial which are designed to cure myeloma patients, even newly diagnosed myeloma patients. So we have a lot of patients going on clinical trial with a curative intent. So it is important for the physicians to know myeloma is curable.

Next is pharma. It is important for pharma industry that myeloma is curable because if you say "this protocol is designed to cure," they want to be part of it. They are even willing to collaborate with the asset with another pharma. Otherwise, they usually don't like—they protect their asset. So that makes a difference. And more important is if you have a definition that if you are in complete remission, MRD negative, year after year, up to five years, at that time we can say if we follow you for next five years without treatment, we could call it a cure. So if you come up with a definition, then pharma industry is very happy to engage in bringing new drugs in earlier in the disease course, and they are able to do clinical trial design—design the clinical trial with a five-year endpoint. You know that is important. And also it allows them, you know, to support newer drugs to come in earlier randomized clinical trial, even in first relapse or one to three relapses. So you are able to develop new drugs, promising drugs, instead of waiting for failing four lines of therapy, five lines of therapy, being introduced at the late stage where the patient is also not physiologically healthy. You're able to bring these effective drugs earlier in the course. So pharma is engaged.

And for the regulatory agencies like FDA, EMA in Europe, you know, having a definition makes them also engage and allow drugs to be approved earlier in different lines of therapy, even in newly diagnosed myeloma patients. So it helps everybody.

Then the question is somebody has to put out what is the definition. So I have put out a definition which later on people will get together and... but it is a challenge. So what is a cure? You know, we I look at the other solid tumors or everything else. If a patient has no trace of cancer in the body and is in no trace of cancer for five years without any ongoing treatment, that is considered as cure, whether it is breast cancer, you know, lymphoma, anything like that. So patient is not on treatment and is cancer-free for five or more years, that is a cure. All right.

But in order to do that, first of all, we have to say first step to cure is complete remission. So we have to define what is a complete remission. So complete remission here everybody will agree complete remission is no trace of cancer in the blood or urine. And of course, serum immunofixation, serum protein electrophoresis, free light chain—these are all common. But there are also newer technologies coming: mass spec to check in the blood. You know it doesn't matter to me how we define no trace of cancer should be there. No trace of cancer in the blood or urine. Okay.

The second is the bone marrow. There is not even one in a million cancer cell in the bone marrow. That means MRD. There is no measurable residual disease—not even one in a million. That technology has been approved by FDA, called ClonoSEQ by the Adaptive. So it is commercially available, could be done in Neeville, Texas, as much as in New York City. Okay, so that is important.

And the third thing is we want to make sure that the patient has been imaged head to toe and functional imaging with PET CT or whole body MRI, and there is no detectable cancer anywhere, because your bone marrow could be MRD negative but you could still have a small lesion in a rib or in a spine or something like that detected by PET—that is still an active disease. So you should have no trace of cancer in the blood, in the bone marrow, and in the whole body functional imaging. That is fantastic.

And one more thing we can add is in the future they may also try to look for DNA in the blood or circulating plasma cells. None of that should be there. Yeah. In no detectable cancer in the blood or urine. Period. Okay. So that is the definition of complete remission. And then this definition should be applicable for newly diagnosed myeloma patients as well as relapsed myeloma patients, even after. So the definition should hold true.

Now the question is has this happened? Why am I saying yes, myeloma is curable? Because we reported in ASCO 2025 as well as in EHA 2025 and actually published in Blood and in Journal of Clinical Oncology patients who participated in CARTITUDE-1 trial which was conducted in 2018, 2019. We did a long-term follow-up of, you know, median follow-up of 61 months, basically five-year follow-up of these patients. And of the 97 patients who participated, one-third of the patients were progression-free. And these patients did not receive any maintenance. It was "one and done" deal. So they received the treatment in 2018, 2019, you know, as cilta-cel infusion. Afterwards, they never got any treatment, and we found that they were alive and progression-free at five years and no... and at my center, 12 of these patients we studied every year as they articulated with blood test, with a bone marrow, with MRD by ClonoSEQ as well as by PET CT. We found that these patients year after year after year for five years they showed no trace of cancer without any ongoing maintenance therapy. That fulfills the criteria I already said what I considered as cure. So we have evidence from a clinical trial which was adjudicated by FDA and the EMA. It was multicenter trial and we showed that the cure definition is being met by a third of the patient and 12 patients really met it. The third I cannot be sure they were not studied as detailed but these 12 patients at my center was studied. So that is why I am now saying myeloma is a curable cancer.

Now, once you say it is a curable cancer, I listen to all the latest in the bispecific antibody, trispecific antibody, and the CAR T. There are so many new CAR T's that are coming. One of the CAR T's Dr. Nupar Raji presented early results in Lancet or some journal where they had only treated eight or nine patients. All they did was they gave the vector as an injection into the IV and the patient's own T-cells were converted to CAR T-cells and they eliminated, and the patients were cancer-free. So they were not waiting for production. They didn't have two months to wait and all these things. Simple injection. I think this is a dramatic news in clinical development. Yeah, obviously I do not know.

Likewise, there are allogeneic CAR T-cells—healthy people donating T-cells which are made into CAR T-cells which are also very effective. Then there are CAR T-cells with two different targets against BCMA against GPRC5D or CD19. All these are coming in pipeline. So the clinical development is very robust. You go on the bispecific antibodies, there are antibodies, you know, already against BCMA. Three different antibodies are approved: teclistamab, elranatamab, and linvoseltamab. Then there are also drugs in the pipeline. There is a trispecific antibody preliminary results from, you know, I studied where they target the BCMA, the GPRC5D, and the CD3 had almost a 100% response rate and deep responses, so you didn't even have to go through CAR T. You were able to put the patient—all the patient complete remission. These are phenomenal developments. So I already showed you we have evidence of cure, in between hospice to cure with the cilta-cel on the CARTITUDE-1 trial. So cure is there.

I just want people to believe there is cure in myeloma. I want the physicians to know there is cure in myeloma. Approach your patient. Treat them as if you're going to cure them. Give them the best clinical trial and options available. I want the patient to feel there is a cure in their lifetime. And all these assets are there ready to help them. And the future is bright.

"How long will I live with multiple myeloma?" If the newly diagnosed myeloma patient comes to me and asks, "Doc, how long I have time to live?" because "I went through the internet, it says an incurable cancer, you know, I have to get priority in my life organized," and it's always an important question for all cancer patients, whether I have breast cancer or, you know, lung cancer or, you know, blood cancer like multiple myeloma, lymphoma. That's an important question. My feeling is now you know that the treatment has dramatically improved, especially I'm going to start you with the four-drug regimen, you know, four different drugs. This shows dramatic response in most of the patients—over 90% of the patients—and in many of them, at least a third or more, it is able to make the cancer go away completely and keep it like that. Then we can add transplant to even improve its effectiveness. But there are also clinical trials coming on where they are looking at CAR T earlier in the disease. But should your cancer come back, my goal is to see whether I cure you or should my initial treatment didn't cure you, there are treatment options with still curative potential even if your cancer comes back. So I would just tell the patient we need to rephrase it: "You're going to live, okay? You're going to live even more than when I'm going to be practicing myeloma." So, you're going to live, but we are going to aim for a cure and we're going to help you.