Minimal Residual Disease in Multiple Myeloma

Mina, Roberto; Bonello, Francesca; Oliva, Stefania

doi:10.1097/ppo.0000000000000519

Cited by 7 publications

(7 citation statements)

References 79 publications

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“…Clinical decisions such as discontinuation, intensification or initiation of a new therapy based on measurable residual disease treatment were confirmed to improve PFS [ 22 ]. Thus, more clinical trials might bring us the endpoint of maintenance [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world prognostic significance of attaining minimal residual disease negativity in newly diagnosed multiple myeloma

Wang,

Li,

Zhang

et al. 2024

Discov Onc

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The aim of the study was to evaluate the prognostic impact of minimal residual disease (MRD) in the real-world setting and the interaction between MRD and molecular risk, clinical response and autologous stem-cell transplant (ASCT). A retrospective analysis of 275 newly diagnosed multiple myeloma (NDMM) patients who achieved very good partial remission (VGPR) or better before maintenance were involved. We examined MRD status by multiparameter flow cytometry (MFC). At a median follow-up of 37 months (4–88 months), In patients who achieved ≥ VGPR, those with MRD negativity had significantly longer PFS (51 vs. 26 months; P < 0.001) and OS (Not reached: NR vs. 62 months, P < 0.001) than those with MRD positivity. MRD positivity was the independent prognostic factor for PFS with hazard ratios of 2.650 (95% CI 1.755–4.033, P < 0.001) and OS with hazard ratios of 2.122 (95% CI 1.155–3.899, P = 0.015). Achieving MRD negativity was able to ameliorate a poor prognosis associated with genetic high risk. MRD negativity was associated with better PFS regardless of ASCT treatment. MRD status was more predictable for clinical outcome than conventional clinical responses. Moreover, Sustained MRD negativity ≥ 12 or ≥ 24 months improved both PFS and OS. Patients with NDMM who achieved MRD-negative status or sustained MRD negativity had deep remission and improved clinical outcomes regardless of high-risk cytogenetics, ASCT and clinical responses in a real-world setting.

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Section: Discussionmentioning

confidence: 99%

Real-world prognostic significance of attaining minimal residual disease negativity in newly diagnosed multiple myeloma

Wang,

Li,

Zhang

et al. 2024

Discov Onc

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“…The need to achieve a sustained MRD negativity over time and the best time points to measure it are still matters of debate. Many ongoing trials are exploring MRD-guided treatments ( 80 ), and their findings will clarify which time points are the most relevant for treatment-decision making. In the future, the use of MRD in clinical practice will follow what is important for treatment-decision making.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification Before and During Treatment in Newly Diagnosed Multiple Myeloma: From Clinical Trials to the Real-World Setting

2022

Self Cite

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Multiple Myeloma (MM) is a hematologic malignancy characterized by a wide clinical and biological heterogeneity leading to different patient outcomes. Various prognostic tools to stratify newly diagnosed (ND)MM patients into different risk groups have been proposed. At baseline, the standard-of-care prognostic score is the Revised International Staging System (R-ISS), which stratifies patients according to widely available serum markers (i.e., albumin, β 2-microglobulin, lactate dehydrogenase) and high-risk cytogenetic abnormalities detected by fluorescence in situ hybridization. Though this score clearly identifies a low-risk and a high-risk population, the majority of patients are categorized as at “intermediate risk”. Although new prognostic factors identified through molecular assays (e.g., gene expression profiling, next-generation sequencing) are now available and may improve risk stratification, the majority of them need specialized centers and bioinformatic expertise that may preclude their broad application in the real-world setting. In the last years, new tools to monitor response and measurable residual disease (MRD) with very high sensitivity after the start of treatment have been developed. MRD analyses both inside and outside the bone marrow have a strong prognostic impact, and the achievement of MRD negativity may counterbalance the high-risk behavior identified at baseline. All these techniques have been developed in clinical trials. However, their efficient application in real-world clinical practice and their potential role to guide treatment-decision making are still open issues. This mini review will cover currently known prognostic factors identified before and during first-line treatment, with a particular focus on their potential applications in real-world clinical practice.

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“…Furthermore, there was a strong relation between Freiberg comorbidity index (FCI) and early relapse and progression partly due to poor tolerance to treatment [11]. Minimal residual disease (MRD) positivity at the end of induction and post consolidation or transplantation is strongly associated with inferior outcomes and early relapse [12].…”

Section: Predictive Factors For Early Relapsementioning

confidence: 99%

Treatment of Multiple Myeloma in the First Relapse

Alhuraiji¹,

Razik²,

Omar³

2023

Recent Updates on Multiple Myeloma

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The treatment scope for relapsed myeloma has been expanded considerably in the last few years, by virtue of the advent of numerous novel agents with new mechanisms of actions. This has resulted in increasing responses and prolonging survival even in advanced diseases. The wealth of novel regimens comes with the challenges of balancing toxicities and aligning a regimen with the biology of myeloma and the nature of relapse in conjunction with the patient’s treatment history, comorbidities, and personal preference. The second-line treatment in myeloma includes new generation of proteasome inhibitors and immunomodulators, CD38 monoclonal antibodies, Panobinostat, and Elotuzumab. Recent randomized trials have shown that triplet combinations incorporating CD38 monoclonal antibodies, dexamethasone along with either proteasome inhibitor or immunomodulator were superior to doublet combinations in terms of response rate and progression-free survival. The choice of the second-line therapy is determined by lenalidomide/bortezomib exposure and resistance and access to new agents. Furthermore, autologous transplantation should be considered in selected cases. Here, we will be discussing the optimal management of multiple myeloma in the first relapse.

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Minimal Residual Disease in Multiple Myeloma

Cited by 7 publications

References 79 publications

Real-world prognostic significance of attaining minimal residual disease negativity in newly diagnosed multiple myeloma

Real-world prognostic significance of attaining minimal residual disease negativity in newly diagnosed multiple myeloma

Risk Stratification Before and During Treatment in Newly Diagnosed Multiple Myeloma: From Clinical Trials to the Real-World Setting

Treatment of Multiple Myeloma in the First Relapse

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