MRD assessment in Multiple Myeloma
Technical evolution and impact for clinical practice
A series of interesting articles have been published recently on Measurable (or minimal) residual disease (MRD) in multiple myeloma. MRD is one of the most powerful prognostic factors for progression-free survival and overall survival in Multiple Myeloma. It is currently evaluated through bone marrow-based assays using multiparametric flow cytometry (MFC) and next-generation sequencing (NGS) and now expanding to sophisticated peripheral blood techniques such as mass spectrometry (MS) based methods. Furthermore, methods and sensitivity for detecting circulating tumor cells (CTCs) and tumor DNA (ctDNA) in the context of multiple myeloma are developing.
Measurable Residual Disease and Decision-Making in Multiple Myeloma
An excellent, must-read review article has been published by Benjamin Derman and Rafael Fonseca with a deep-dive into the evolving technical aspects of MRD testing and impact when implementing MRD-adapted decision-making in clinical practice.
Measurable Residual Disease by Mass Spectrometry and NextGeneration Flow to Assess Treatment Response in Myeloma
The group of Dr. Derman published results of their investigations on the MSbased assessment of M protein in peripheral blood, indicating that the MS approach represents a favorable, non-invasive strategy, that even would facilitate frequent evaluations of the kinetics of response at least complementary to the periodic bone marrow evaluations.
Low circulating tumor cell levels correlate with favorable outcomes and distinct biological features in multiple myeloma.
The experts from the group of Dr. Terpos describe a study on the clinical utility of MM circulating tumor cells (CTCs) and provide evidence toward a consensus cutoff for risk stratification. By applying next-generation flow cytometry in bone marrow and matched peripheral blood samples the authors defined an optimal CTC cutoff for both transplant-eligible and transplant-ineligible newly diagnosed MM patients.
Measurable Residual Disease Testing in Multiple Myeloma Routine Clinical Practice: A Modified Delphi Study
A study using a modified Delphi approach found consensus on the importance of MRD testing in managing MM. Experts agreed that MRD testing should be done in NDMM or RRMM patients who achieve complete response (CR) or better after transplantation. For transplant-ineligible patients, MRD testing is recommended for those ≤70 years old and in CR.
Podcasts
For even more details and explanation on MRD we highly recommend you listen to interesting podcasts with various international experts:
- MRD as primary endpoint – Myeloma Platform Dr. Ola Landgren from Sylvester
Comprehensive Cancer Center, University of Miami. US. - Minimal Residual Disease (MRD) – Cost vs Benefit – Myeloma Platform
Dr. Fredrik Schjesvold from Oslo Myeloma Center in Norway - Decoding Multiple Myeloma genetic profile -The Power of Liquid Biopsy-Derived DNA
with Dr. Wouter de Brouwer from University Hospital, Belgium.
