Determination of Minimal Residual Disease in Multiple Myeloma: Does It Matter?
Purpose of Review
The ability to detect minimal residual disease (MRD) in myeloma has improved due to advances in flow cytometry and sequencing methodologies. Here, we evaluate recent clinical trial data and explore the current and future roles of MRD assessment in the context of clinical trial design and clinical practice.
A review of recent phase III studies reveals that achievement of MRD negativity is associated with improved progression-free survival (PFS) and/or overall survival (OS). Treatment arms that are more effective from a PFS or overall response rate perspective are also associated with superior MRD negativity rates. The current standard MRD methodologies are limited by requiring bone marrow samples and refinement of methodologies that can detect disease outside of the bone marrow is needed.
Currently, MRD is a prognostic biomarker and further efforts are required to determine whether it can serve as a surrogate endpoint. The use of MRD status to guide treatment decisions is currently not recommended outside the confines of a clinical trial.
KeywordsMultiple myeloma Minimal residual disease Overall survival
SK, JH, PLM, and SAH have no acknowledgments for this work.
Compliance with Ethical Standards
Conflict of Interest
Shalin Kothari declares no potential conflicts of interest. Jens Hillengass reports received honoraria and travel support from Amgen, Bristol-Myers Squibb, Celgene, Janssen, Novartis, Takeda and research funding from Celgene and Sanofi, outside the submitted work. Philip McCarthy reports receiving honoraria from Bristol-Myers Squibb, Celgene, Sanofi-Aventis, Takeda and Binding Site, research funding from Celgene, and has served on advisory committees/review panels/board membership for Bristol-Myers Squibb, Celgene, Sanofi-Aventis, Takeda, Binding Site and Karyopharm, outside the submitted work. Sarah Holstein reports receiving honoraria from Adaptive Biotechnologies, Celgene, Takeda and has served on advisory committees/review panels for Celgene, Takeda, Adaptive Biotechnologies, Sorrento, GlaxoSmithKline, outside the submitted work.
Human and Animal Rights
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
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