Is There a Cure for Myeloma?

Maybe — for some with standard risk myeloma, but it depends on your personal definition of a "cure."

That was the honest, unresolved answer at the center of a packed session at this year's International Myeloma Society (IMS) meeting, "Are We Ready to Say 'Cure' in Multiple Myeloma?" For a disease that oncologists were mocking the idea of "curing" as recently as 2010, even asking the question out loud is new territory.

A word patients have been waiting to hear

Jenny Ahlstrom, MS — Founder and CEO of the HealthTree Foundation, a global nonprofit dedicated to improving outcomes and finding cures for blood cancers, and a myeloma patient herself since 2010 — opened the session by admitting how personal the topic had become. Nearly five years past CAR-T therapy, with one more bone marrow biopsy standing between her and meeting a newly proposed clinical definition of cure, she put the question to the room plainly: Am I cured?

It's not a rhetorical question anymore. The International Myeloma Society has floated real criteria: sustained complete response, MRD-negativity by next-generation sequencing, five years off all therapy, clean functional imaging. For the first time, "cure" has a proposed checklist instead of just being an word doctors avoided.

Why the checklist isn't the whole story

Two things happened at IMS that complicate the tidy version of this story.

First, the data is genuinely encouraging on both sides of modern treatment. Long-term follow-up from CARTITUDE-1 (presented first at ASCO 2026) shows a third of heavily pre-treated patients alive and progression-free three to five years after a single CAR-T infusion — no maintenance therapy required. Bispecific antibody combinations are posting similarly strong numbers, with teclistamab plus daratumumab (Tec-Dara) hitting 83% progression-free survival at three years. Dr. Fredrik Schjesvold, MD, PhD — founder and head of the Oslo Myeloma Center at Oslo University Hospital and national coordinator of more than 30 myeloma clinical trials — put it directly: "We can define cure, but to prove it, we need fixed-duration strategies and to stop treatment."

Second, clinicians on the panel spent as much time arguing about what to call this progress as they did celebrating it. Dr. Rahul Banerjee, MD, FACP, Associate Professor of Medicine at Fred Hutchinson Cancer Center and a member of the International Myeloma Working Group, explained cure to patients as "achieving a normal life expectancy." Schjesvold rejected the term "functional cure" outright, comparing it to calling myeloma a "chronic disease" — either the disease is gone, or it isn't.

Team Spider-Man vs. Team Hulk: a friendly debate with no losing side

The sharpest, and friendliest, disagreement of the day came down to strategy: if CAR-T and bispecific antibodies are both legitimate roads toward cure, which one should patients take first?

Dr. Banerjee argued "Team Spider-Man" — bispecifics like Tec-Dara — using the case of a 76-year-old with high-risk disease (del 17p) who relapsed just 12 months after frontline therapy, a "functional high-risk" pattern where standard approaches tend to fail fast. In that exact population, Tec-Dara posted a 77% three-year progression-free survival rate versus 0% with standard care. Newer safety protocols — prophylactic tocilizumab, which cuts cytokine release syndrome rates from roughly 50% down to under 10%, plus prophylactic IVIG — have made bispecifics considerably safer than they were even two years ago. And because they're off-the-shelf, bispecifics can be given at community clinics, not just tertiary academic centers, and emerging fixed-duration protocols (like the LimiTTless trial) are starting to give patients real treatment-free intervals rather than indefinite therapy. Author's note: Other bispecific and monoclonal antibody combinations—such as elranatamab plus daratumumab—are currently in Phase 3 trials and are expected to show comparable outcomes. Enrolling in these trials can be an attractive strategy today: participants receive cutting-edge therapy alongside structured minimal residual disease (MRD) monitoring, while often offsetting the high costs of specialized testing required to track long-term remission.

Dr. Gurbakhash Kaur, MD, a multiple myeloma specialist at the Icahn School of Medicine at Mount Sinai, made the case for "Team Hulk" — CAR-T first — using a more standard-risk case: a patient who achieved an MRD-negative complete response after transplant and maintenance, then experienced a slow biochemical relapse. Her argument: EHA and IMWG guidelines already favor CAR-T before bispecifics, CARTITUDE-4 data show a single cilta-cel infusion can produce deep, durable remission with a genuine treatment-free interval, and — critically for sequencing — prior bispecific exposure measurably weakens a later CAR-T response, while CAR-T first doesn't compromise a bispecific used afterward. Her summary of the approach: "Hit the disease with maximum force upfront to smash the tumor burden down to zero."

Both sides cited efficacy numbers that keep proving to remain high with each year's trial readout, and the audience's own re-vote at the end of the session still leaned CAR-T (roughly 80%) — but the panel was clear that there's no single right answer. Risk level (standard vs. high-risk vs. functional high-risk), how a patient weighs a one-time infusion against ongoing but reversible treatment, and access to a specialized center all shift the calculus. Myeloma care has entered an era where patients get an actual choice in first- and second-line therapy — which makes knowing what a patient values most, not just what a trial proves, part of the treatment decision itself.

Author's note: Other bispecific and monoclonal antibody combinations—such as elranatamab plus daratumumab—are currently in Phase 3 trials and are expected to show comparable outcomes. Enrolling in these trials can be an attractive strategy today: participants receive cutting-edge therapy alongside structured minimal residual disease (MRD) monitoring, while often offsetting the high costs of specialized testing required to track long-term remission.

Does IVIG count as "still on treatment"?

One question that came up almost in passing turned out to be one of the thorniest of the day: what about supportive care that never stops?

Continuous bispecific therapy and CAR T-cell therapy can wear down T-cells enough that patients develop recurring, serious infections — the standard fix is routine IVIG (intravenous immunoglobulin) infusions to prop up a weakened immune system. Currently, most biscific patients can stop IVIG use about 6 months after stoping therapy, however for CAR T-cell therapy this is still an area of open investigation. Importantly, IVIG isn't chemotherapy and doesn't target myeloma directly. But it's also not nothing: for some patients it means an infusion appointment every few weeks, and for some this it will be indefinitely, because of what treatment did to their learned immune system — not because the cancer is still there.

So if a patient has zero evidence of disease for five years or more but still needs chronic IVIG for permanent immune damage, are they cured? Or still, in some meaningful sense, a patient? The IMS criteria is silent on this, because it's built around disease status, not treatment burden. But it's exactly the kind of distinction patients care about — and it's precisely why HealthTree's new survey asks directly: if the cancer itself is gone but you still need ongoing supportive therapy for a past side effect, does that fit your definition of "cured"?

The gap nobody's data can fill

Here's what the researchers can't answer from a clinical trial: what does "cured" need to feel like to actually count?

HealthTree ran a survey in 2022, in partnership with the University of Utah's Huntsman Cancer Institute, asking exactly that. Of more than 1,500 patients:

• 75.8% defined cure as permanently stopping treatment with no evidence of disease — full stop, not a lab value.

• 76.3% had never even heard the term "functional cure."

Jenny told the room those numbers are exactly why the phrase has to go: "Patients do not hear the word 'functional'; they just hear the word 'cure.' It might make sense for clinicians, but not for patients. It's unclear language — patients don't know if that means on treatment, off treatment, with or without a monoclonal protein. To patients, cure is binary: cure means stopping therapy."

The clinicians on the panel, it turned out, were already there. Asked how they view "functional cure" next to the new IMS definition, Schjesvold didn't hedge: "I never liked the term 'functional cure.' It's similar to calling it a 'chronic disease.' To me, either the disease is gone, or it is still there and can relapse. We shouldn't use 'functional cure' until patients are truly at deep, sustained levels off treatment." Another panelist pointed to the benchmark used in other cancers — five years disease-free off treatment in solid tumors or Hodgkin lymphoma — and added that "functional cure" sounds too much like "functional medicine," an Instagram buzzword: "Patients want real cure." Banerjee offered the plain-language alternative he uses in clinic, explaining it to patients as achieving a normal life expectancy: living as long as they would have without the diagnosis.

So patients and clinicians largely agree the old label has to go. What they haven't settled is what should replace it — and that matters, because the definition on the table asks patients to do real things to earn the word. Would you get five bone marrow biopsies over five years to make a "cure" label official? Drive three hours to a specialized center for the imaging that confirms it? Stop maintenance therapy the moment your doctor says you might be cured, even knowing relapse in myeloma is often silent — caught on a lab test, not felt? Every patient answers those questions differently, and right now the people writing the clinical definition are mostly guessing at those answers.