To improve is to change, to be perfect is to change often.

Winston Churchill

Treatment of multiple myeloma (MM) has changed drastically in the last ten years with proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and CAR T-cell therapies. The induction therapy I received prior to my stem cell transplant may very well be considered malpractice by most myeloma specialists in today’s world. Understanding the biology of the myeloma cancer cell, therapy now has the capability/potential to be directed to a specific cellular mechanism of that cell.

In addition to new drugs, there are advances in how therapies are biochemically measured and monitored for Minimal Residual Disease (MRD). These measurements may suggest an endpoint of treatment of the myeloma and of the maintenance therapy after a stem cell transplant. Cytogenetic features of individual myeloma cells may also determine a successful line of therapy with a very specific drug.

I received maintenance treatment after my stem cell transplant when it was still controversial, and now it is considered standard treatment protocol. The drug for maintenance may now be tailored to a specific genetic profile of the myeloma cancer cell so that “high-risk” myeloma would warrant a more specific drug or drugs.

These advances are leading to an increase in the survival outcomes among myeloma patient; and in the future, we all hope for a cure. I am extremely fortunate to once again attend the American Society of Hematology’s (ASH) Annual Meeting this year in New Orleans to learn more about the new “changes” in the treatment of multiple myeloma.