Measurable Residual Disease: The Future of Assessing Treatment Efficacy in Myeloma?
Posted: Tuesday, January 14, 2020
Although the assessment of measurable residual disease is a standard of care in many tumor types, its clinical applicability in multiple myeloma has remained unclear. A study published in the Journal of Clinical Oncology indicates that the International Myeloma Working Group next-generation flow cytometry minimal residual disease (MRD)–negative criterion appears to be an effective tool to evaluate treatment efficacy in patients with newly diagnosed multiple myeloma. The diagnostic method is “highly applicable and sensitive,” stated Bruno Paiva, PhD, of the Clinica Universidad de Navarra, Pamplona, Spain, and colleagues.
The authors evaluated 458 patients with newly diagnosed multiple myeloma treated with 6 induction cycles of bortezomib, lenalidomide, and dexamethasone (VRD); autologous transplantation; and two consolidation courses with VRD as part of the PETHEMA/GEM2012MENOS65 trial. In the 208 patients (45%) who achieved undetectable MRD after consolidation, there was an 82% reduction in the risk of disease progression or death and an 88% reduction in the risk of death compared with patients with persistent disease. The timing of achieving undetectable MRD status did not seem to impact survival, according to the investigators, and the positive effect of attaining undetectable MRD seemed to counteract poor prognostic features at diagnosis such as high-risk cytogenetics.
The authors noted that patients with a Revised International Staging System III status and persistent MRD had “dismal” progression-free survival and overall survival of 14 and 17 months, respectively.
“This observation is clinically meaningful, because these patients should be offered alternative treatment strategies before insurmountable disease progression occurs,” they concluded.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.