Benjamin Diamond, MD, a hematology-oncology fellow at Memorial Sloan Kettering Cancer Center, discusses the need to integrate minimal residual disease (MRD) testing into clinical trials in multiple myeloma.

Although MRD does not currently inform treatment decisions for patients with multiple myeloma, MRD-oriented clinical trials are needed to determine the utility of MRD negativity in this patient population. Moreover, some clinical trials are incorporating risk-adapted approaches based on MRD, says Diamond. In these studies, patients undergo MRD assessment a number of years following induction and maintenance therapy. Then, based on the results of the test, patients may continue on their treatment or de-escalate therapy, Diamond explains. 

In practice, patients may be allowed to defer stem cell transplant if they are MRD negative following induction therapy, Diamond says. This is based on findings from the phase 3 IFM 2009 trial (NCT01191060), which showed that time to second objective disease progression and overall survival was similar whether patients received an early or delayed transplant, Diamond concludes.

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Benjamin Diamond, MD, discusses the need to integrate minimal residual disease testing into clinical trials in multiple myeloma.  



Dr. Diamond on the Need to Integrate MRD Testing Into Clinical Trials in Multiple Myeloma 

Benjamin Diamond, MD, a hematology-oncology fellow at Memorial Sloan Kettering Cancer Center, discusses the rationale for examining long-term minimal residual disease (MRD) in patients with multiple myeloma.

A need exists to examine what serial MRD testing means in the context of continuous maintenance therapy, which is a standard of care for all patients with newly diagnosed multiple myeloma, according to Diamond. While sustained MRD negativity over the course of 1 year is prognostically good for patients, not much is being done with this information, Diamond says.

As patients are being treated with maintenance therapy for many years, it is sensible to examine what MRD status indicates during that time, and what changes in status can mean for outcomes—specifically with regard to progression-free survival. For example, a trial conducted at Memorial Sloan Kettering Cancer Center examined MRD dynamics. The investigators checked the MRD status of participants every year who had received continuous lenalidomide maintenance therapy. This is just one of the many efforts being made to examine the role of MRD in multiple myeloma, Diamond concludes.

Benjamin Diamond, MD, discusses the rationale for examining long-term minimal residual disease in patients with multiple myeloma.

Benjamin Diamond, MD

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Dr. Diamond on the Need to Integrate MRD Testing Into Clinical Trials in Multiple Myeloma

Dr. Diamond on the Rationale for Examining Long-Term MRD in Myeloma