Today I will be talking about the recent advances in the treatment and biology of multiple myeloma. As you are all aware, multiple myeloma is a malignant proliferation of plasma cells, those cells that we all have that produce the antibodies that defend us against infection. For reasons which we do not know, one of these cells becomes malignant and that malignant proliferation can cause multiple problems – bone lesions that lead to fracture, marrow infiltration that leads to recurrent infections and anaemia which leads to fatigue, and eventually kidney and multi-organ failure. There have been dramatic advances in the treatment and the understanding of the biology of myeloma over the last fifteen years. We now understand that myeloma is not one disease but multiple diseases characterised by multiple cytogenetic abnormalities. We now know that there’s an optimal initial treatment for myeloma which is the combination of drugs called IMiDs, immune modulatory drugs, and drugs that belong to the proteasome inhibitors such as bortezomib, carfilzomib, and dexamethasone or steroids.

We know now that we can get 70-80% of people to achieve major responses with induction treatment. Notwithstanding, I will also talk about the importance of consolidation therapy – the treatment we give after induction to achieve deep remissions, deep, what we call, complete remissions that with novel technology we can even detect minimal residual disease to a level of one in a million cells or more. This is important to achieve long-term disease control.

I will also finish my talk talking about the relevance of continuous therapy. This is maintenance therapy with either lenalidomide or proteasome inhibitors. I will finalise my talk to talk about new strategies such as the monoclonal antibodies that have recently become commercially available such as daratumumab and elotuzumab. I will talk about the CAR T-cells, these exciting cells that have been shown to be able to eliminate malignant plasma cells and malignant leukaemia cells and malignant lymphoma cells in patients who have failed multiple prior treatments.

It is a great time for hope in patients with multiple myeloma. Notwithstanding, access still is a problem and only 30% of patients achieve or are able to get what we consider optimal therapy at this time. We’re asking patients to continue to support clinical trials by participating in them and to continue to be engaged with their advocacy group. It is a true pleasure to be here in Miami today and to be able to join my colleagues in what is the continued fight against myeloma.