Table 1 Roadmap of what to do in the next ten years to bring about a meaningful cure fraction for multiple myeloma.
Pillar | Key actions |
|---|---|
Early diagnosis / Treatment-entry refinement | - Improve risk stratification in SMM: integrate clinical, cytogenetic, immune, and imaging/genomic data. - Use AI models for predicting progression and defining when to intervene. - Use functional imaging early to detect occult organ or focal disease. |
Maximal depth of response | - Use quadruplet induction (PI + IMiD + CD38 antibody + steroid) for transplant-eligible; similar depth-oriented regimens for others. - Ensure consolidation to convert residual disease. - Achieve MRD negativity at sensitivity ≥10⁻⁶, validated by both marrow and imaging. |
Durability and synchronized treatment duration | - Define and validate standards: standard risk ( ~ 2 years of sustained MRD negativity), high risk ( ~ 3+ years), including imaging negative. - Trial of fixed-duration therapy in patients achieving sustained MRD negativity versus ongoing therapy. - Careful monitoring to detect relapse early and safely restart if needed. |
Safety, quality of life and fitness adaptation | - Ensure tolerable toxicity profile: prophylaxis, supportive care, management of immune suppression. - Incorporate frailty assessment; adapt regimens for older or less fit patients. - Collect patient-reported outcomes in trials (quality of life, functional status). |
Infrastructure and research | - Standardize MRD and imaging assays; set common definitions. - Support multicenter, randomized, MRD-driven trials. - Deploy AI and systems biology to model microenvironment, immune surveillance. - Ensure long-term data (5+ years off therapy) are collected. |
