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Having studied conventional multiple myeloma (MM) for years now, I can understand why oncology needs to add the term “functional cure” as well as the term “relative survival” to the term “true cure.” Because conventional oncology can’t provide a “true cure” to MM patients and survivors, they need to slice and dice the issue in an effort to obfuscate the issue as much as possible.
When I was first diagnosed with MM in 1994 and meeting with myeloma experts in an effort to better understand my incurable blood cancer, my wife and I met with Dr. Durie in Los Angeles at Cedar-Sinai. I found Dr. Durie to be very knowledgable. More importantly, I found Dr. Durie to be a good person. I think the IMF does good work.
As a long-term multple myeloma (MM) survivor however, I don’t think there are three different definitions for what it means to cure MM. At least not to a newly diagnosed MM patient, survivor or caregiver anyway.
It is important, however, for MM patients, survivors and caregivers to understand these three terms because their oncologists may use them at any given time during their diagnosis and treatment. For example, if your oncologist recommends what he/she refers to a “potentially curative therapy” then you need to understand what he/she means. At least you must understand that no MM patient has ever been truly cured by an allogenaic stem cell transplant. These patients may have endured painful short, long-term and late stage side effects but never a true cure.
Dr. Durie knows this is the meaning of cure because he concludes the discussion below with what I consider the actual definition of the word cure for MM. “And so, the BOTTOM LINE is that a cure can be considered in a variety of ways, but perhaps the simplest way that I really like is to say that a MM patient grows old and dies from something other than myeloma.”
I don’t think “cure” for MM can be considered in a variety of ways. But then again, I’m not a board certified oncologist. I’m only a long-term MM survivor.
Have you been diagnosed with multiple myeloma? Scroll down the page, post a question or comment.
There are three ways cure can be considered: functional cure, relative survival, and true cure.
“This week’s “Ask Dr. Durie” comes from a patient who wants to know, “What is cure?” And this is a very reasonable question from a patient who has been watching this word used a lot on the internet in discussions about new treatments for myeloma. And, what do we really mean by cure for myeloma patients?
And so, there have been three ways of looking at what cure might mean for patients with myeloma. The first one that’s been used for a number of years is what’s called “Functional Cure.” And this is a situation where a patient has had an excellent response to treatment but has a little bit of myeloma left but is stable and is in remission perhaps five years, ten years, or even twenty years from diagnosis, but clearly is not completely eradicated from having myeloma.
The second type of way of looking at cure is to say that a MM patient has the same survival of a similar type of individual, of the same sex, of the same age, but who do not have MM. And this is called “relative survival” where the relative survival versus a matched individual without myeloma is the same. And so, this is also called a “cure fraction” in some publications. So, this is a second way of looking at cure.
The third way is what one could call true cure, where you have looked in every sensitive way that you can to try to find evidence of myeloma remaining in the body, using testing for minimal residual disease, using PET/CT scanning, every technique that we have to see if there is any evidence of MM and finding none, one can say that a patient may be truly cured.
And so, the BOTTOM LINE is that a cure can be considered in a variety of ways, but perhaps the simplest way that I really like is to say that a MM patient grows old and dies from something other than myeloma. And this would be truly wonderful and truly meet any and every definition of CU.