Evolving Treatment Goals in Multiple Myeloma

Dr. Saad Usmani and Dr. Shaji Kumar discuss how treatment goals and measures of clinical benefit have evolved in newly diagnosed multiple myeloma. Dr. Usmani highlights the shift from relying primarily on overall response rate and progression-free survival toward incorporating measurable residual disease (MRD) negativity as an important endpoint, given its association with survival outcomes and its emerging role in regulatory evaluation. Dr. Kumar emphasizes that the deeper responses achieved with quadruplet regimens in both transplant-eligible and transplant-ineligible multiple myeloma have been associated with improved clinical outcomes, supporting the importance of treatment depth. The discussion then turns to older patients with multiple myeloma, particularly those aged 80 years and older or those younger patients who may not tolerate quadruplet therapy. Dr. Kumar notes that these patients were not represented in trials such as PERSEUS and emphasizes the relevance of data from MAIA, where daratumumab plus lenalidomide and dexamethasone demonstrated durable disease control and tolerability in transplant-ineligible patients. The experts highlight how CD38-directed therapy has contributed to increasingly durable PFS outcomes in older patients.