The Future of Myeloma Treatment: Ajai Chari, MD

In this clip, Ajai Chari, MD, professor of clinical medicine and director of the Multiple Myeloma Program at the University of California, San Francisco, weighed in on where multiple myeloma (MM) treatment is headed as a menu of therapeutics continues to expand the treatment landscape.

Concluding his recent interview with The American Journal of Managed Care^®, Chari pointed to an early sign of standardization: quadruplet regimens are increasingly becoming frontline therapy for newly diagnosed patients, regardless of age or transplant eligibility. But he cautioned against expecting a single, universal algorithm since myeloma affects an extraordinarily diverse population, each with different comorbidities, renal function, and cardiac health.

Because of this variability, Chari argued that treatment decisions must weigh not only efficacy and safety but also convenience, cost, quality of life, and patient-reported outcomes. As treatment options multiply, he predicted myeloma care will increasingly follow a shared decision-making model, where physicians present options and patients help determine what matters most to them rather than a one-size-fits-all approach.

On the question of functional cure, Chari was optimistic. He recalled patients once headed toward hospice who achieved stringent complete remissions with earlier generations of therapy. He highlighted CARTITUDE-1 trial (NCT03548207) data showing roughly a third of heavily pretreated patients achieving long-term remission, along with the unprecedented HRs seen in the MajesTEC-3 study (NCT05083169).

For Chari, curing myeloma depends on 2 components: effective therapy, which he believes now exists, and sufficiently sensitive tools to detect residual disease. He noted that relying solely on M-spike measurements would miss patients detectable only through light chains and that newer methods, including minimal residual disease testing in the bone marrow, mass spectrometry, and circulating tumor DNA, now allow for detection of microscopic disease that earlier tools would have missed.

He urged the field to move away from characterizing myeloma as an incurable chronic disease and instead strive explicitly for a cure as a goal, acknowledging that a guarantee isn’t possible for every patient, but that setting the bar lower risks never reaching it.

As he put it, “We’re striving for a cure. Doesn’t mean we can guarantee it for every patient, but let’s strive for it.”