Dr. Larson on the Impact of MRD on Treatment Decisions in Multiple Myeloma

Sarah M. Larson, MD, assistant professor of medicine, and director, Multiple Myeloma Program, University of California, Los Angeles, discusses the impact of minimal residual disease (MRD) on treatment decisions in multiple myeloma.

With the many treatment advances made in multiple myeloma, patients are now achieving MRD negativity, says Larson. However, the specific way to achieve MRD negativity and the implications on practice remain largely unknown in the frontline setting following stem cell transplant. Following transplant, there’s also the discussion of maintenance and whether lenalidomide (Revlimid), ixazomib (Ninlaro), or a combination should be administered, adds Larson. Whether MRD testing should be done with maintenance therapy, similar to stem cell transplant, is also an open question.

In terms of frontline clinical trials, the field is anticipating data from the phase II GRIFFIN trial and the phase III COBRA trial. In the GRIFFIN trial, investigators are evaluating bortezomib, lenalidomide, and dexamethasone (VRd) versus VRd plus daratumumab (Darzalex). Initial results seemed to favor the daratumumab arm, but more mature data are needed. In the COBRA trial, investigators are evaluating carfilzomib (Kyprolis), lenalidomide, and dexamethasone (KRd) versus VRd, which, if positive, could be practice changing, concludes Larson.