**10. Curability of available treatment options**

Multiple myeloma is curable if an intensive combination regime is used upfront. Long-term complete remission becomes a more important factor than reaching complete remission. Complete remission that lasts more than three years is the first milestone on the road towards curability in [36]. It is necessary to accentuate that in the light of current knowledge and longterm experience with intensive regimens, the possibility of curing MM patients is being discussed from the end of 2011 in [37]. The first report, at the time very provocative, was presented at ASH in 2009 suggesting the possibility of a cure in 2009 in [29]. This was a major breakthrough in the observation of this malignant disease.

Which MM patients have a chance of a cure and what is that chance? Curability depends on reaching a deep and constant complete remission which is most probable and possible in MM patients with a favorable prognosis suitable for autologous transplantation. Of which are treated by an intensive combination treatment composed of the most effectively available drugs. These drugs are set into a complex block of entry induction therapy followed by maintenance therapy. Curability is possible only in patients with a low-risk based on gene expression profiles and cytogenetics based on experience from Total Therapy 3 treatment protocols in [30]. It is important to realize how many patients really have this chance. Of all MM patients, about 40% are involved in intensive treatments. Out of these patients, about 80% are low risk which means about 32% of entry number. To simplify the calculation, about 75% of these patients reach complete remission (24% of entry numbers), and up to 85-90% of these patients reach long-term complete remission (21% of entry numbers) with a chance of cura‐ bility at about 50-60% (10-12% of entry numbers) in [29,36,30]. Thus, based on available data, a qualified estimate would suggest that a chance for cure is possible for 10% of MM patients and 25% of patients who are able to undergo intensive treatments including myeloablation. These results changed natural course of the disease (Fig.2); moreover, they were impossible 20 years ago.

modulate another 5-6 active parts of the disease and offer long-term survival of more than 10

Strategies for the Treatment of Multiple Myeloma in 2013: Moving Toward the Cure

http://dx.doi.org/10.5772/55366

9

Faculty of Medicine University Ostrava and Faculty Hospital Ostrava, Czech Republic

[1] Kumar, S. K, Rajkumar, S. V, Dispenzieri, A, et al. Improved Survival in Multiple Myeloma and the Impact of Novel Therapies. Blood (2008). , 111(5), 2516-20.

[2] Offidani, M, Corvatta, L, Morabito, F, et al. How to Treat Patients with Relapsed/ Refractory Multiple Myeloma: Evidence-Based Information and Opinions. Expert

[3] San Miguel JF., Schlag R., Khuageva N.K. et al. VISTA Trial Investigators. Bortezo‐ mib Plus Melphalan and Prednisone for Initial Treatment of Multiple Myeloma. N

[4] Palumbo, A, Bringhen, S, Liberati, A. M, et al. Oral Melphalan, Prednisone, and Tha‐ lidomide in Elderly Patients with Multiple Myeloma: Updated Results of a Random‐

[5] Palumbo, A, Adam, Z, Kropff, M, et al. A Phase 3 Study Evaluating the Eficacy and Safety of Lenalidomide(Len) Combined with Melphalan and Prednisone Folowed by Continoues Lenalidomide Maintenance (MPR-R) in Patients ? 65 Years(Yrs) with Newly Diagnosed Multiple Myeloma(NDMM): Updated Results from Pts Aged Yrs

[6] Morgan, G. J, Davies, F. E, Gregory, W. M, et al. Cyclophosphamide, Thalidomide, and Dexamethasone (CTD) as Initial Therapy for Patients with Multiple Myeloma

[7] Morgan, G. J, Davies, F. E, Gregory, W. M, et al. Cyclophosphamide, Thalidomide, and Dexamethasone as Induction Therapy for Newly Diagnosed Multiple Myeloma Patients Destined for Autologous Stem-cell Transplantation: MRC Myeloma IX

[8] Landgren, O, Kyle, R. A, Pfeiffer, R. M, et al. Monoclonal Gammopathy of Undeter‐ mined Significance (MGUS) Consistently Precedes Multiple Myeloma: a Prospective

Unsuitable for Autologous Transplantation. Blood (2011). , 118(5), 1231-1238.

Randomized Trial Results. Haematologica (2012). , 97(3), 442-50.

years to more than 1/3 of the patients.

Opin Investig Drugs (2011). , 20(6), 779-93.

ized Controlled Trial. Blood (2008). , 112(8), 3107-14.

Enrolled in MM-015. Blood (2011). Abstract 475., 65-75.

Engl J Med (2008). , 359(9), 906-17.

Study. Blood (2009). , 113, 5412-5417.

**Author details**

Roman Hajek

**References**

**Figure 2.** Natural history of multiple myeloma can be changed

#### **11. Summary**

In 2012, we can announce MM to be a curable disease under favorable prognostic conditions at the time of diagnosis and using intensive therapy in about 10% of MM patients. Relapsed MM or disease progression is not curable using current treatment options with the exception of allogeneic transplants in some cases. Due to highly efficient drugs, especially proteasome inhibitors and immunomodulatory drugs, our current treatment options are such that we can modulate another 5-6 active parts of the disease and offer long-term survival of more than 10 years to more than 1/3 of the patients.
