I have said Dr. Barlogie is the Wizard of Ark, and over the years he has proven the " hit it hard up front" approach of Total Therapy works for the majority of low risk (85%) patients. I asked him if MRD would be a corner stone to the treatment of myeloma, and he said that it would be important but he had seen CR and MRD negative disease which still showed active lesions in the bone marrow. His point was it would be the combination of clear and clean imaging with MRD negativity which would be an important element of treatment.
Dr. Barlogie gave me his most recent publication which was titled, "Curing myeloma at last: defining criteria and providing the evidence." It is an exceptionally well written article which was published in Blood and is 26 pages long, and if you want to do some midnight reading CLICK HERE. The net of this is the average survival at 10 years is 60% for the most recent Total Therapy trial TT3a, and an estimate for average life expectancy will likely be close to 14 years, or over 3 times the average reported by the National Cancer Institute. In addition, they believe 50% of low risk patients will be CURED.
I have questioned why Total Therapy is not a standard treatment in the USA, and I have been told by many it is aggressive and more importantly it has never been compared to other treatments of myeloma in a blind clinical trial. UAMS has stated it was a moral dilemma to put people in the non Total Therapy side of the trial and that is why they have not conducted such a trial. However, if there were a trial of 400 people, 200 would be in the non TT side of the trial, whereas the benefit might apply to the 25,000 newly diagnosed each year. In addition, the non TT side of the trial could opt out at any time and go into the TT leg if MRD and imaging proves the non TT leg to be inferior. This I believe is a clinical trial that is already 12 years late.
Good luck and may God Bless your Cancer Journey. For more information on multiple myeloma survival rates and treatments CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1