Peripheral Residual Disease Monitoring Signals Progression Risk in Multiple Myeloma

Peripheral residual disease identified using next-generation flow in patients with transplant-eligible multiple myeloma was associated with a 13-fold increased risk of progression or death, according to a clinical trial update published online ahead of print in the Journal of Clinical Oncology.

“In multiple myeloma, measurable residual disease is assessed in bone marrow. However, less invasive evaluation of peripheral residual disease in blood could be advantageous and less cumbersome,” wrote first author Marta Lasa, PhD, of the Cancer Center Clinica Universidad de Navarra in Pamplona, Spain, and study coauthors.

The study included 138 transplant-eligible patients with multiple myeloma from the GEM2012MENOS65/GEM2014MAIN clinical trials. Researchers investigated the prognostic value of peripheral residual disease monitoring using next-generation flow and mass spectrometry after patients underwent 24 cycles of maintenance treatment.

Among the 138 patients, 16 patients had peripheral residual disease detected by next-generation flow. Peripheral residual disease detected on next-generation flow was associated with a 13-fold higher risk of progression and/or death, a median progression-free survival of 2.5 months, and an overall survival of 47 months, according to the study.

Detection of peripheral residual disease using next-generation flow showed a positive predictive value of 100% and a negative predictive value of 73%, using measurable residual disease in bone marrow as the reference, researchers reported.

Patients with undetectable peripheral residual disease on both next-generation flow and mass spectrometry had a 2-year progression-free survival rate of 97% and a 2-year overall survival rate of 100%, the study found. However, only measurable residual disease in bone marrow and peripheral residual disease by next-generation flow showed independent prognostic value for progression-free survival in multivariate analyses.

“This study supports the use of less invasive peripheral residual disease monitoring during maintenance or observation in transplant-eligible patients with multiple myeloma,” researchers wrote.

Reference

Lasa M, Notarfranchi L, Agullo C, et al. Minimally invasive assessment of peripheral residual disease during maintenance or observation in transplant-eligible patients with multiple myeloma. J Clin Oncol. Published online October 1, 2024. doi:10.1200/JCO.24.00635