Dr. Landgren Discusses Risk and Treatment in Myeloma

Ola Landgren, MD, PhD, Head, Multiple Myeloma Section, National Cancer Institute, discusses the relationship between risk and treatment in patients with multiple myeloma.

In multiple myeloma an important decision needs to be made regarding whether blood tests or other tests should be done to choose therapy in high-risk patients or if standard-risk patients should be chosen to receive the best drugs. One could argue, Landgren says, that these standard-risk patients will have the greatest upside. As high-risk patients have only a slightly improved outcome even with the best therapies, it may be time to rethink and give this population completely different agents.

In addition, the duration of therapies may need to change. The true role of extended dosing and maintenance therapy needs further investigation, Landgren says, as well as the role of measuring responses using minimal residual disease. Clinical trials examining new agents require complete response as an endpoint; however, Landgren believes minimal residual disease could be a new endpoint for these trials. As a consensus needs to be reached to define this new endpoint, the talk now is essentially focused on a cure for multiple myeloma.