After 180 Years, Multiple Myeloma Gets a Definition of Cure

The word “cure” was seldom used in multiple myeloma (MM) until the CARTITUDE-1 trial (NCT03548207), which showed that a single infusion of ciltacaptagene autoluecel (cilta-cel, Carvykti; Janssen Biotech, Inc/Legend Biotech) led to 5-year remission in one-third of patients.¹

These results led the International Myeloma Working Group to update their consensus definition. Now, newly diagnosed or relapsed refractory MM (NDMM, RRMM) may be considered cured after 5 years in complete remission without any treatment.²

The shift is notable for a disease that has historically been difficult to treat and fatal, offering many patients new hope.

“For many years, multiple myeloma has been described as treatable but not curable. Today, scientific advances have brought us closer to defining what “cure” means,” said Nikhil C. Munshi, MD, a founding member and immediate past president of IMS, a professor of medicine at Harvard Medical School, the Kraft Family Chair, and director of basic and correlative science at Dana-Farber Cancer Institute's Jerome Lipper Multiple Myeloma Center.²

“The depth and durability of responses we are now seeing, along with major progress in MRD testing and modern therapies, have moved the field to a point where we can see that a cure exists and examine how it should be defined.”²

What Does the New Consensus Establish?

The new definition sets a 5-year bar, but it is a specific and fairly demanding 5 years. A patient with NDMM and RRMM may be considered cured after five years in complete remission with no myeloma treatment at all. The clock starts when treatment stops, not from whenever the patient first became disease-free while still being treated. Ongoing drug therapy does not count; the definition is built specifically to separate a durable, unassisted remission from a well-controlled chronic disease.²

To meet the bar, patients need all of the following²:

• At least 4 negative MRD tests, including 1 at the 5-year mark, with no positive result anywhere in between.
• MRD testing is sensitive enough to detect one myeloma cell in one million, using next-generation sequencing or next-generation flow.
• Advanced imaging (PET/CT or diffusion-weighted whole-body MRI) showing no disease at the start and end of the observation period, with no positive scan at any point if additional imaging is performed along the way.

How Will This Affect Pharmacists?

For oncology pharmacists, a formal cure definition isn't just semantics—it reframes several practical conversations that come up constantly in myeloma care:

MRD testing becomes a treatment-duration question, not just a prognostic one. The definition explicitly requires four consecutive negative results using 10⁻⁶-sensitivity NGS or NGF testing. As MRD-adapted treatment and maintenance-discontinuation strategies (such as those being tested in MIDAS [NCT04934475] and reported in PERSEUS's [NCT03710603] long-term follow-up) become more common, pharmacists are going to be fielding more questions from patients about whether a given MRD result means treatment could eventually stop altogether—and this framework gives that conversation actual criteria to point to, rather than a vague "we'll see."²

"Off treatment" is now a defined clinical end point, not just a patient preference. Distinguishing a drug-free cure from a drug-controlled remission has direct implications for how aggressively maintenance therapy is pursued and for how patients and clinicians think about the tradeoffs of stopping therapy early versus continuing indefinitely.²

Expectation-setting with patients changes. A disease that's been described as incurable for nearly 2 centuries now has a rigorous, named threshold that some patients may realistically be counted toward. That is a meaningfully different conversation to have at the infusion chair or during a maintenance-therapy consult than the treatable-not-curable framing pharmacists have relied on for years.²

“We are no longer debating whether a cure is possible,” Munshi said. “We are defining it rigorously, measuring it precisely, and expanding the number of patients who can achieve it—with clarity, discipline, and real hope.”²

REFERENCES

1. Jagannath S, Martin T, Cohen A, et al. Long-term (≥5-Year) remission and survival after treatment with ciltacabtagene autoleucel in CARTITUDE-1 patients with relapsed/refractory multiple myeloma. June 3, 2025. doi:10.1200/JCO-25-00760

2. Munshi N. International Myeloma Society, International Myeloma Working Group. IMS/IMWG consensus definition of cure in multiple myeloma. 23rd International Myeloma Society Annual Meeting; September 23-26, 2026; Glasgow, Scotland.