Exploring Minimal Residual Disease in Multiple Myeloma

Exploring Minimal Residual Disease in Multiple Myeloma

MRD testing frequency varies based on patient preference and disease characteristics, with testing intervals ranging from 3-6 months post-transplant to annual assessments. Patient education regarding anti-CD38 antibody interference with routine monoclonal protein measurements helps prevent unnecessary anxiety about residual M-protein positivity that may represent antibody rather than disease. Well-informed patients often request comprehensive disease monitoring, and MRD testing provides reassurance about deep disease control.

The role of sustained MRD negativity in guiding maintenance discontinuation remains investigational. Retrospective data suggest that patients maintaining MRD negativity at years two and three post-transplant may be candidates for treatment breaks, though prospective validation is lacking. Many patients tolerating lenalidomide maintenance well are hesitant to discontinue therapy despite sustained MRD negativity, viewing it as protective rather than potentially unnecessary.

Annual MRD assessment aligns with standard post-transplant monitoring schedules at most centers, providing a balance between comprehensive disease monitoring and avoiding excessive testing. Individual patient desires for information must be balanced against potential anxiety from overly frequent monitoring. The decision to continue or discontinue maintenance in the setting of sustained MRD negativity requires consideration of tolerance, side effects, patient preference, and the recognition that prospective data supporting discontinuation remain limited.