Earlier this year the IMF launched the Black Swan Research Initiative, a breakthrough approach to finding a cure for myeloma. Following in our footsteps, others are ramping up their myeloma research efforts. This is great news for myeloma patients, and in science it’s particularly useful to have lots of people examining data in different ways.

But BSRI’s unique approach to finding a definitive cure for myeloma continues to set it apart from all other myeloma research efforts in the following fundamental ways:

  • BSRI is an actual research project aimed at finding a functional cure for myeloma, not an open-access platform to support external research.
  • A core tenet of BSRI is that many patients might be cured and don’t know it – because previously we have lacked the sophisticated tests necessary to determine that Zero Minimal Residual Disease – MRD-Zero – has been achieved. The change in available testing will inform and refine BSRI protocols to highlight a pathway to a cure. Using the latest procedures involving flow cytometry and full DNA sequencing, we will be able to detect down to less than one cell per million of myeloma.  Thus, we can identify who has been cured, and what combinations of therapies led to that cure.
  • Using Big Data to look for individual differences, as others are doing, is expensive, difficult and – if the process includes developing a new drug for each patient – time-consuming. What makes more sense is BSRI’s strategy of using Big Data to find the similarities among patients in large, distinct groups. If the BSRI testing protocols find, for example, a patient with “Category A” characteristics has reached MRD-Zero, then the same treatment course can be applied to others in Category A. Will the cured patient’s therapy regime work on all similar patients? No – but when itdoes work that will yield a new, more refined set of characteristics, a “Category A-1” that responds in like manner. And so on.
  • Others are attempting to use individual molecular data to develop new targets for drugs. In other words, find a mutation, target the mutation. This sounds great but is a long, arduous process that in general does not work. Better to avoid the mutations that occur in myeloma cells over time by treating the myeloma early. To do so, BSRI proposes administering therapy that is known to work in combinations of multiple mechanisms. Improved detection of the disease and its clones will allow us to monitor the therapy – and determine what’s working – from an early point in the disease.

Understanding the molecular genetics of minimal residual disease (MRD) and using the best combinations of drugs to eliminate the MRD will lead to cures. To get there, we are currently carefully designing precise studies in clinical trial settings that will begin early next year.

In the meantime, we wish all myeloma researchers success. When it comes to the Black Swan Research Initiative, we expect success.

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF Hotline staff instead. Questions are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate. To contact the IMF Hotline, call  800-452-CURE, toll-free in the US and Canada, or send an email to hotline@myeloma.org. Hotline hours are 9 am to 4 pm PST. Friday summer hours are 9 am to 3 pm PDT. Thank  you.

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