A long-term follow-up study has found that up to one-third of patients with newly diagnosed multiple myeloma (MM) may achieve long-term survival through early “total therapy” protocols, demonstrating the lasting impact of immunomodulatory drugs and proteasome inhibitors.
The analysis reviewed data from three clinical trials (TT 1, TT 2, TT 3A) conducted between 1989 and 2006, involving 1,202 patients treated at the University of Arkansas for Medical Sciences. Patients were followed for a median of over 16 years, with some observed for up to 25 years. Survival outcomes improved significantly across the trials. The estimated cure fraction, based on relative survival, rose from 20% in TT 1, to 37% with thalidomide in TT 2, and 43% with the addition of bortezomib in TT 3A. Median overall survival reached around 12 years in TT 3A, with 15-year survival rates of 45% in standard-risk patients.
Ten-year progression-free survival increased from 9% in TT 1 to 44% in TT 3A. In later trials, relative survival approached that of the general population within 5 to 10 years, earlier than seen in earlier protocols.
These results highlight the cumulative benefit of combining chemotherapy, stem cell transplant, and novel agents in a time-limited treatment strategy. While not all patients are cured, the findings offer real hope for long-term remission and underscore the importance of continued innovation in MM therapy.
Helena Bradbury, EMJ
Reference
Hadidi S Al et al. Long-Term follow-up of patients with multiple myeloma treated on earlier total therapy protocols: A secondary analysis of 3 clinical trials. JAMA Oncol. 2025; doi: 10.1001/jamaoncol.2025.1394.
