Dr. Mailankody on MRD-Negative Status in Multiple Myeloma

Sham Mailankody, MBBS, assistant attending physician, Memorial Sloan Kettering Cancer Center, discusses minimal residual disease (MRD) negativity in multiple myeloma.

Studies show that achieving MRD negativity is associated with better progression-free survival and overall survival; however, it is unclear whether treatment decisions should be driven by MRD-negative status, explains Mailankody. This question is being actively investigated at the Memorial Sloan Kettering Cancer Center where investigators are testing the MRD status of patients at different time points, including at the end of induction, the end of transplant, and when doing follow-up at maintenance. MRD is tested using flow cytometry and next-generation sequencing, which Mailankody believes provides valuable prognostic information.

These tests are used on a case-by-case basis to determine whether treatments need to be tailored. For example, for patients who achieve MRD-negative status after induction, patients are given the option of collecting their stem cells and deferring consolidated autologous transplant to the time of relapse, says Mailankody. Although this practice is not yet established based on large randomized studies, emerging evidence suggests that this is a reasonable strategy for a select group of patients with newly diagnosed multiple myeloma, adds Mailankody.

A remaining question has to do with whether an MRD-negative patient who is on maintenance for an extended period of time can come off of maintenance therapy safely, or if they need to remain on that therapy indefinitely. Clinical trials are needed to explore this question further and those trials are either being designed or are ongoing, concludes Mailankody.