IMS 2026 | IMS 2026 highlights: evolving multiple myeloma treatment and the path toward cure

Well we are here in the beautiful city of Glasgow in Scotland for the 23rd International Myeloma Society annual meeting and this is a fantastic gathering lots of new data lots of content, and lots of friendship within the myeloma community. So it can take hours to discuss all the highlights of this IMS Congress, but maybe I can focus on a couple of key practical issues. I think the treatment of the front lines, newly diagnosed multiple myeloma, is becoming more and more established. Whether we are in the transplant setting or in the non-transplant setting, I think those patients who are fit enough should receive a quadruplet regimen, including an anti-CD38, bortezomib, lenalidomide, and dexamethasone. In the transplant setting, we can debate whether we should replace bortezomib with carfilzomib. There are data with carfilzomib. Some colleagues think that a second-generation proteome inhibitor may work better. The number of cycles for induction is also debated, and more and more the field is moving into longer inductions, let’s say six cycles. As you may guess, the role of high-dose melphalan is becoming more and more highly debated. And I believe there is a sort of a controversy. In general, the European community and the rest of the world, I say, outside the United States of America, is still much in favor of giving high-dose melphalan. In the U.S., the model is slightly different, where it doesn’t look like autotransplanted high-dose melphalan remains a favorite treatment. Nevertheless, there is the issue of maintenance therapy, and I think more and more people are moving now from single maintenance, and the superstar has been always lenalidomide, and now I think it’s about an anti-CD38 plus lenalidomide. But then, of course, comes the duration of the treatment, and I think this is good news. We are debating more and more the issue of fixed duration versus continuous duration. Until very recently same efficacy, less toxicity, and pharmacoeconomically, that would be interesting. And in addition, in general, the quality of life when you stop treatment is much better. And I think this question is relevant and now becoming important because of the high level of efficacy of the treatments we have and the capacity to induce a very deep and sustained MRD negativity. And this is why, actually, the concept of cure now in multiple myeloma is becoming a reality and this is why the IMS and the IMW group have defined recently the criteria to speak about cure in multiple myeloma. So you can see the frontline setting things are becoming well and very well established and our assumption is that patients can enjoy a very long disease-free survival or progression-free survival period. Now, for those patients in relapse, I think the debate now is between immunotherapies, whether cellular therapies or T-cell engages, bispecific, even tri-specific, or eventually antibody-drug conjugates. And we see superb results with all of these candidates, actually. And, of course, the $1 billion question, or here in the UK, the £1 billion question, is about how can we choose between these different options, because, obviously, we do not have head-to-head comparison. But I think these options exist, and the results are very good, whatever you choose. Now, having said this, if the immune therapies, the CAR T cells, the T cell engages, the antibody-drug conjugates are able to deliver such great responses and outcome in the relapse setting, why not moving them into earlier lines? And this is what we are eagerly awaiting for the next two, three, or four years because there are several trials challenging, actually, the role of autotransplant in the frontline setting, but also actually introducing the immunotherapies like bispecific antibodies into the frontline setting in combination with an anti-CD38 monoclonal antibody. So you can see at the end of the day, I think my take-home message from this IMS is that for the near future, probably the treatment algorithm of multiple myeloma is going to be relatively straightforward about maximum two lines of treatment incorporating immunotherapy as soon as possible. And this is really great news, and I personally feel very privileged witnessing all of these advances, but we should not forget that the majority of the patients across the globe are not able to access and afford these innovations. And this has been discussed during this IMS meeting, and I think it’s our collegial and group responsibility to advocate for availability, accessibility and affordability.

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