Benefits of MRD Testing for the Treatment of Patients With Multiple Myeloma

At the 2023 Lymphoma, Leukemia & Myeloma Congress in New York, Joseph Mikhael, MD, MEd, FRCPC, FACP, Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, argued in favor of minimal residual disease (MRD) testing for patients with multiple myeloma, in both a research setting and in clinical practice. 

Transcript:

Hello. My name is Dr Joseph Mikhael. I'm a professor at the Translational Genomics Research Institute in Phoenix, Arizona, which is part of the City of Hope Cancer Center, and I'm here today at the Lymphoma, Leukemia, and Myeloma Conference in lovely New York City.

I have the privilege of debating Dr Jim Berenson today [about the] utility of MRD, or minimal residual disease testing. And specifically, I am addressing the issue of the fact that MRD, now and its testing, is valuable, not only in a research parameter, but indeed in clinical practice. And there's so many reasons for this, and this is why Dr Berenson will shamelessly lose this debate, but the key points are as follows.

We know, unequivocally, that the depth of response, and we've always known the depth of response correlates to outcomes, but [with] MRD negativity, it does indeed reflect prognostically how a patient will do, but it also is a surrogate marker of both progression-free and overall survival. So, there's no doubt that this is an incredibly important tool for us. Although we're still working out exactly how we would use that tool day-to-day in clinical practice, there is no doubt that we're already using it and will be using it more so, even as right now in regular clinical practice, we make changes based on the depth of one's response.

We are reviewing many of the trials and the studies that have been done, and now real-world evidence, to support the fact that MRD negativity, along with other tools and parameters, can really make a difference in clinical practice. It may cause you, at some points, to stop treatment. At other points, if it remains persistently positive, we may extend or change someone's therapy because we know, despite the complexity of the disease, that MRD testing tells us a lot about that individual patient, and we want to put it in its right context. 

The bottom line, MRD is here to stay. It has influenced almost every single talk in myeloma at this conference, and indeed now we're using it in clinical practice, and we need to be able to use it wisely.

Source:
 

Mikhael J. Debate: MRD is Necessary Determinant on Outcomes Both in Clinical Practice and Clinical Research. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-21, 2023. New York, NY