Evaluating the Use of MRD in Multiple Myeloma Treatment

At the 2024 Lymphoma, Leukemia & Myeloma Congress in New York, New York, Joshua Richter, MD, Tisch Cancer Institute at Mount Sinai, New York, New York, discusses the role of measurable residual disease (MRD) in the treatment of patients with multiple myeloma.

Transcript:

Hi, I am Dr. Josh Richter. I am an associate professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai and the director of myeloma at the Blavatnik Family Chelsea Medical Center at Mount Sinai. I'm really excited to be here at LL&M 2024 talking about the role of MRD in multiple myeloma.

The title of my presentation is “MRD: Is it ready for prime time?” The short answer is no, but I think there's a lot of caveats with that. We've known for a number of years that depth of response in myeloma matters in general; deeper response correlates with more durable outcomes. What we don't know is whether or not changing therapy to achieve MRD negativity changes outcomes.

For example, in ALL, we know that with induction, if you don't achieve MRD negativity, if we give you additional therapy and convert you to MRD-negative, that changes the [] of your disease.

In myeloma, we don't have that prospective data yet. We have older data from the day and age where we just used complete remission. For patients that didn't get CR, adding more therapy deepened their responses, but didn't lead to better and PFS didn't lead to better OS.

So, this is a really evolving field and there is some good data out there. Using MRD from the Oncologic Drugs Advisory Committee (ODAC) and FDA to get drugs approved earlier—big fan of. Getting drugs in the hands of our patients is wonderful.

There's some wonderful ongoing clinical trials like the SWOG 1803 DRAMMATIC study that's going to look at in the maintenance setting, if you become MRD negative, can we stop, or deescalate, your maintenance care? But right now, it's not clear to me that we should be using it to make these big clinical decisions.

The other downside is there's a psychological impact. You sit down with a patient that blood work is negative, scan is negative, routine bone marrow is negative—but you found 10 bad cells amongst 9 million. That really upsets them. They walk out of that not feeling elated that they're in a complete remission, not feeling elated that their scans are negative, not elated that their blood is negative, but focusing on the 10 bad cells that they found.

And guess what? Even if you're MRD negative, there's still disease beneath that. So it's an evolving field. We're learning a lot. We're starting to figure out where to incorporate it, but I don't think it's quite ready for primetime.

Source:

Richter J. Is MRD Ready for Prime Time? Presented at Lymphoma, Leukemia & Myeloma Congress; October 16-19, 2024. New York, NY.