KEY POINTS

1. Starting Treatment
   • This means starting treatment by mouth or injection (or both), which is known to wipe out myeloma cells.
   • Since all treatments have both short and long-term side effects, any such treatment must be medically necessary, and benefits must far outweigh unwanted side effects.
   • Medically necessary means that "CRAB" or related features are having an important impact by causing bone damage, kidney or heart failure, recurrent or serious infections, or nerve/neurologic damage.
   • The intent is to start treatment when the trend of active disease is clear, but before major or irreversible damage has occurred.
     
     
2. Treatment Philosophies
   There are two philosophies, Cure vs Control:
   
   
   • Cure- therapies directed at attempting to achieve a cure
     Cure is a hope, not a reality.  A term "functional cure" has been introduced by some who define it as complete remission lasting more than 4 years. Although this is an excellent goal within clinical trials, it unfortunately does not translate into permanent cure.  Detailed testing typically reveals that patients in complete remission have small amounts of myeloma remaining, which can lead to relapse. Advocates feel that since it can be months or years until relapse occurs, "functional cure" is a reasonable goal.
     
     
   • Control- therapies directed at achieving long-term disease control and maximum quality of life benefits
     Control on the other hand has become very much an achievable reality. With the introduction of novel drugs, such as Thalidomide, Velcade®, and Revlimid® within the last decade, long-term disease control (in remission) is a reality for many patients.
     
     
   It is important to know your doctor’s philosophy in approaching your case. The argument is about the pros and cons of ongoing therapy needed to achieve and sustain the disease with respect to the impact of therapy upon quality of remission. The overall survival benefit with both the "cure" and "control" approaches can be substantial. The controversial question is: which is currently better or preferable?
   ASH 2011 presentations that address STEP 3

   REFERENCES

   ©2011 International Myeloma Foundation