Turning Corners in Myeloma Care

This year’s presentations on multiple myeloma at the American Society of Clinical Oncology (ASCO) Annual Meeting, particularly the phase 3 studies, are a testament to the remarkable evolution of the treatment landscape. From deepened measurable residual disease (MRD) responses to the promise of one-time cellular therapies, the research shared offers both clinical depth and hope for a future in which multiple myeloma may not only be managed but potentially cured.

One of the central themes across several studies is MRD—specifically the relevance of achieving and sustaining MRD negativity at increasingly sensitive thresholds (10^-5 and 10^-6). In the MIDAS trial, investigators examining an MRD-adapted strategy using isatuximab, carfilzomib, lenalidomide, and dexamethasone (Isa-KRd) showed that patients who had achieved MRD negativity after six induction cycles did not see deepened MRD benefits from autologous stem cell transplantation (ASCT) compared with IsaKRd consolidation alone. The same principle applied for patients who did not achieve MRD negativity with regard to a tandem ASCT versus single ASCT. Although we await data on sustained MRD negativity and progression-free survival (PFS), this strategy holds promise for personalizing care and potentially sparing some patients from the toxicities of ASCT in the future.

The mode of administration for these novel therapies is also receiving attention, with the IRAKLIA study addressing a longstanding concern: the patient experience during monoclonal antibody infusion. Isatuximab delivered subcutaneously demonstrated noninferiority in efficacy and pharmacokinetics compared to intravenous administration, with fewer infusion-related reactions and greater patient satisfaction. With comparable safety and no new adverse signals, subcutaneous isatuximab via an on-body delivery system (which does not require as much active attention from nurses during administration) offers not only convenience, but also potential improvements in clinical workflow—and possibly an avenue toward home-based self-administration in the future.

Perhaps the most paradigm-shifting data in myeloma came from the CARTITUDE-1 study, which reported 5-year follow-up data for patients with heavily pre-treated multiple myeloma with a median of six prior lines of therapy following a single infusion of ciltacabtagene autoleucel (cilta-cel). Remarkably, 33% of patients remain alive and disease-free at five years. This is the first compelling evidence in a prospective trial from the modern era suggesting a potential cure with chimeric antigen receptor (CAR) T-cell therapy for myeloma, a disease historically defined by inevitable relapses. Future work is needed to identify and mitigate risk factors for delayed toxicities and complications following CAR-T therapy, including parkinsonism and second primary malignancies. Regardless, the durability of responses seen in CARTITUDE-1 is both scientifically and emotionally profound.

Together, these studies underscore the dual pillars shaping the future of myeloma care: personalized, MRD-guided strategies and innovative therapies capable of inducing deeper, more durable remissions. Although questions remain—particularly around long-term outcomes and sequencing—these data hint at a treatment era in which decisions are based not only on staging at diagnosis, but also on biologic response over time. Even for patients with multiple prior relapses, ASCO 2025 has shown us that the future of myeloma is brighter than ever—and for some patients, the elusive goal of a cure may be within reach.

Krina Patel, MD, MSc is an Associate Professor in the Department of Lymphoma and Myeloma within the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas. She is a dedicated physician-scientist whose research focuses on advancing treatments and improving outcomes for patients with multiple myeloma and other plasma cell disorders, including POEMS syndrome, Waldenström’s macroglobulinemia, plasmablastic lymphoma, and amyloidosis.

Rahul Banerjee, MD, is a physician and researcher specializing in multiple myeloma, a blood cancer that affects plasma cells and can lead to bone and kidney complications. He also treats patients with AL amyloidosis, a related but less common condition that requires a multidisciplinary approach involving specialists in oncology, nephrology, and cardiology.