ASH 2024 | Should we treat smoldering multiple myeloma?

Yeah, it’s a great question, and we are answering it with multiple studies. The first thing is you’re treating those patients for a very fixed duration, short time, and you’re leaving them alone. So if the clone will grow someday later on, five, seven years, eight years from now, it will be without the evidence of a clonal inhibition or a drug that’s trying to inhibit it and cause clonal selection. It will basically be trying to come back as if it was myeloma again, de novo. And we actually have whole genome sequencing data that shows that you are not causing clonal selection in many of those patients, and we’ll continue to do that. The second thing is the dara study that is being presented, the AQUILA study, showed that PFS2, which is when you go on to receive active myeloma therapy, was actually improved in the patients who had dara previously, indicating that, indeed, you do not have an effect on those patients. They’re a single agent, not their RVd. But the hope is that you are causing a remission, MRD negative, and then leaving those patients alone. And some of them hopefully will have years and years and years without evidence of disease. And maybe we can redefine what cure is in those patients. And in those who will have evidence of coming back, we will have many agents to treat them with five years from now, six years from now. And potentially, even if they wanted to get dara-RVd again and it will give them the response, maybe that will be the evidence that indeed you can reuse the same drugs five years later.

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