01/09/2026
"To Cure Myeloma?" Check out the doctors that answer that question along with Dr. James R. Berenson. BerensonCancerCenter.com
The Quest to Cure Myeloma: Mission Accomplished?
— The answer depends on the question -- and what the patient really wants
by Charles Bankhead, Senior Editor, MedPage Today
January 4, 2026 • 6 min read
In June 2025, we reported on a study that showed long-term survival with undetectable disease in heavily pretreated multiple myeloma. The results not only added fresh evidence of efficacy for CAR T-cell therapy but more fuel for the ongoing debate about the potential for permanent myeloma cure. Here, we revisit the issue with more data and some strong opinions.
Long-term survival in the CARTITUDE-1 trial showed that almost half of patients remained, alive with a median overall survival (OS) of 60.7 months. Almost three-fourths of the survivors remained progression free, and more than a fourth had undetectable disease.
Treated only with a single infusion of ciltacabtagene autoleucel (cilta-cel, Carvykti) CAR T-cell therapy, the patients' "remarkable" clinical course suggested "a potential cure, or at bare minimum, unprecedented durability of complete response," said Peter Voorhees, MD, of Wake Forest School of Medicine in Charlotte, North Carolina, at the American Society of Clinical Oncology (ASCO) meeting.
Typically, such heavily pretreated patients have a "dismal prognosis," associated with median overall survival (OS) of about 1 year, Voorhees and colleagues noted in an article published simultaneously in the Journal of Clinical Oncology.
ASCO discussant Krina Patel, MD, of the University of Texas MD Anderson Cancer Center in Houston, called cilta-cel "the first potential functional cure for patients with modern-day relapsed/refractory multiple myeloma."
Another study reported at ASCO suggested that long-term disease-free survival might be possible without stem-cell transplantation, the historical goal for achieving a cure in myeloma. The study from France showed that patients with minimal residual disease (MRD)-negative (undetectable) status after induction therapy had similarly favorable outcomes with a transplant (single or tandem) or a four-drug consolidation regimen.
The buzz created by the CARTITUDE-1 results carried over to the Society of Hematologic Oncology meeting in September, when organizers made a late addition to the program for a review and discussion of the trial results. CARTITUDE-1 investigator Sundar Jagannath, MD, of the Icahn School of Medicine at Mount Sinai in New York City, said, "It is time to say 'cure' in multiple myeloma."
"Why is defining cure important?" he continued. "To me, personally, it's very important. That's why I keep harping on it. For patients, it gives hope that they can be cured, not inflicted with an incurable, always-fatal disease."
In a subsequent interview with MedPage Today, Jagannath said "we should get rid of" terminology that implies less than cure to patients, such as "long survival with good quality of life."
"We can cure patients," he insisted.
To Jagannath, cure means long periods of disease-free survival as defined by minimal residual disease (MRD) criteria, 10-5 or 10-6 cells in bone marrow. Many hematologists agree, including Patel, who cited the same criteria in her discussion of the CARTITUDE-1 results.
On the flip side of the issue, some myeloma specialists think MRD criteria are unattainable for many patients (three fourths of the long-term survivors in CARTITUDE-1) and that having MRD as the clinical goal may lead to overtreatment. Additionally, considering the advanced age of many myeloma patients, some might consider the prospect of long-term survival with good quality of life as a "win."
"I think, unfortunately, what's happening is people [hematologists] are taking a sledgehammer to patients," said long-time myeloma clinician and researcher James Berenson, MD, of the Institute for Myeloma & Bone Cancer Research and Berenson Cancer Center in West Hollywood, California. "Of course, when you have treatments that cost a million dollars a year, there's a big financial incentive."
Berenson and colleagues recently reported updated findings from an unselected cohort of 175 patients with newly diagnosed multiple myeloma, dating back to 2006. Most of the patients (N=128) started treatment with the three-drug regimen of dexamethasone, bortezomib (Velcade), and pegylated liposomal doxorubicin, plus lenalidomide (Revlimid) in 11 cases. The latest results showed the "longest median overall survival to date" of 152 months.
None of the patients underwent a stem-cell transplant upfront and none received the most advanced therapies now available for myeloma, such as CAR T-cell therapy and bi-specific antibodies. Berenson and colleagues cited another randomized trial that showed no OS advantage with a stem-cell transplant over a regimen of bortezomib, lenalidomide, and dexamethasone.
Berenson questions the use of MRD to define myeloma disease status, referring to the metric as "minimal ridiculous disease."
"The problem with myeloma is it's very heterogeneous," he said. "You can put a needle in the left iliac spine and you find no myeloma, but in the right, it's riddled [with disease]. I see that all the time. I'm like, 'What does that mean?'"
Additionally, modern mass spectroscopy-based measurement can quantify myeloma cells at even lower levels than some of the assays currently being used to assess MRD status.
"The problem is that you can't measure the protein, so the disease is worsening, but it isn't the level where you can detect it," said Berenson. "With mass spec, we're finding that these 40-month remissions are really like 6 or 7 months."
Is being able to tell patients they are cured overrated?
"If people can sustain a good quality of life without being cured, or intermittently have disease come back that is easily controlled, so what?" said Berenson. "As long as it's being controlled with treatments that aren't negatively impacting the patient quality of life, that is what I think the ultimate goal is. I don't think the goal is necessarily cure, in a way that you then leave people behind who die of the procedures."
Navigating the "cure" conversation with patients can be tricky, said Rahul Banerjee, MD, of Fred Hutch Cancer Center in Seattle. Part of the trickiness comes from myeloma specialists' lack of agreement on what the word even means. For Banerjee, and a growing number of hematologists, the term "functional cure" makes sense and also appeals to many patients.
"You may still be MRD-positive, you may still have some abnormalities in the blood work," he told MedPage Today. "The myeloma is there. It's not gone. It's just there in a quiet state, in a dormant state... . They're neither in remission nor are they cured. But they're probably going to live their whole life without needing a treatment change for myeloma."
"I tell [patients] that compared to an age-matched 70-year-old, your twin somewhere else in America who has the same chronic conditions as you but doesn't have myeloma, you'll live as long as they will," Banerjee added. "That's been my goal, I'm actually satisfied with that. I think that goal is attainable."
Surbhi Sidana, MD, of Stanford Medicine in California, counts herself among the myeloma specialists who think the term "cure" has value and offers hope for many patients. She also sees potential value in extending the definition to include "functional cure." The International Myeloma Working Group (IMWG), of which she is a member, has begun working on new criteria for describing treatment response (used in clinical trials of myeloma), and for the first time, functional cure will be incorporated into the guidelines.
In February, the International Myeloma Society will meet the cure issue head on in the Myeloma Cure Summit: Definitions, Metrics, and Milestones. A primary goal will be to reach a consensus on the definition of "cure."
Sidana, chair of the IMWG committee on patient-reported outcomes, told her colleagues, "Let's ask the patients. What does cure mean to them? Does cure mean being off treatment? Does cure mean you don't have to think about myeloma? Does it mean it never comes up in your past medical history? Does cure mean you're on a pill or an injection every few weeks and you go about your life? We don't know what patients think, what cure means to them."
Charles Bankhead is a senior editor, with primary responsibility for oncology, as well as urology, ophthallmology, and dermatology. He joined MedPage Today in 2007. Connect:
