Luciano Costa, MD, Discusses the Changing Treatment Paradigm in Myeloma

Luciano Costa, MD, PhD, professor of medicine and director of the Multiple Myeloma Research and Treatment Program at the O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, speaks with Targeted Oncology^TM about the evolving treatment paradigm in myeloma during the 23rd International Myeloma Society (IMS) Annual Meeting & Exposition, held September 23-26, 2026, in Glasgow, Scotland.

Costa describes the field as being in the midst of a rapid transformation, one moving so quickly that treatment guidelines are often out of date before they can be finalized. New efficacy and safety data continue to reshape standard approaches faster than they can be codified, he says, underscoring how quickly the evidence base in myeloma is turning over.

The more fundamental shift Costa points to is in how long a course of treatment most patients can expect to need. Historically, myeloma has been managed as a chronic, relapsing disease, with patients cycling through successive lines of therapy as each regimen eventually fails. Costa says that model is giving way to one in which the vast majority of patients will require only one, at most 2, lines of therapy over the course of their disease.

Importantly, Costa is careful to frame this not as a narrowing of options, but as a reflection of how effective current therapies have become. As he put it, patients aren't being limited to fewer lines of treatment because alternatives are lacking; rather, "that's all it takes for them to restore their normal life expectancy." In other words, deep and durable responses achieved earlier in the treatment course are increasingly sufficient to return patients to a normal life span, reducing the need for the multiple rounds of treatment success and failure that have long defined myeloma care.