Bone Marrow Assessment of MRD as a Prognostic Tool in Multiple Myeloma

By: Joshua D. Madera, MS
Posted: Thursday, June 1, 2023

For patients with multiple myeloma who received chimeric antigen receptor (CAR) T-cell therapy, continued early bone marrow evaluation of measurable residual disease (MRD) may serve as an efficacious prognostic tool, according to a study published in Blood Cancer Journal. In addition, routine monitoring of free light chain levels may also provide valuable insight into patients’ overall survival, suggested Yi Lin, MD, PhD, of the Mayo Clinic, Rochester, Minnesota, and colleagues.

From 2016 to 2021, a total of 60 patients with multiple myeloma who received CAR T-cell therapy were retrospectively analyzed. All patients had a history of lymphodepletion chemotherapy with cyclophosphamide and fludarabine. Patients received serial bone marrow assessments during the examination period to determine their MRD status. In addition, the level of free light chains was measured at the 1-month timepoint.

The study findings revealed that at the 1-month timepoint, 78% of patients were classified as MRD-negative through bone marrow analysis. Furthermore, 85% of patients showed evidence of a substantial decline in the number of uninvolved and involved free light chains, which was below the normal threshold. A total of 38% of patients who achieved MRD negativity demonstrated hypercellularity within their bone marrow samples. However, 50% of these patients recovered to normal cellularity. Moreover, patients who achieved MRD negativity had improved rates of progression-free survival (17.5 months) compared with patients who did not (2.9 months). A positive association was revealed between patients with free light chain levels below the normal threshold and prolonged survival.

Disclosure: For full disclosures of the study authors, visit nature.com.

Blood Cancer Journal

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