Assessing the Strength of Minimal Residual Disease Testing for Patients With Multiple Myeloma

Gareth Morgan, MD, New York University (NYU) Langone Health, New York, New York, argues in favor of using minimal residual disease (MRD) testing for patients with multiple myeloma (MM), which he discussed at the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, New York. 

Transcript:

Hi, my name is Gareth Morgan. I'm a professor of hematology at NYU Langone [Health] in New York City. I'm talking about the debate we had with Josh Richter [Joshua Richter, MD, Mount Sinai] about the role of MRD testing in multiple myeloma.

I found myself supporting MRD testing detection for many reasons because, during the course of my career, I've seen improvements in therapy for multiple myeloma that have occurred without increasing toxicity. In fact, there's a decrease in toxicity now compared to what we saw in the past.

I think MRD is achievable, irrespective of age. It's associated with the optimum outcome. So, as we've got deeper responses, we've seen more prolonged progression-free and overall survival. Achieving MRD negativity is an essential prerequisite for cure because it can be achieved with minimal toxicity and doesn't necessarily need autologous stem cell transplantation. But, if you're to take advantage of this or this progress, then you need a tool to monitor it. If you don't know how deep you're going, a lot of the times detectable disease can become undetectable, but you don't know how deep the response is below that level.

If you know that thing, then you can really take advantage of it to adjust your patient management. But it's always important to remember that, for some people, it is not 100% essential to eradicate all types of disease [that] revert[s] to a [monoclonal gammopathy of undetermined significance] MGUS-like phase [and] can be stable for a prolonged period of time.

I see [that in] the role of MRD detection, you can monitor induction treatment, you can monitor maintenance, you can predict long-term outcome[s] based on the depth of response, and you can detect early relapse.

The way forward with this test is to have a level of sensitivity that you're confident in that's specified for the test that you're using and this approach of adjusting treatment based on the depth of response I think has some real traction for patients in the next few years. The importance of the approach I think is really illustrated by the amount of attention that [is] being paid to this by the [Food and Drug Administration] (FDA), in particular, who are looking at the role of MRD levels as being surrogate end points for progression-free and overall survival.

So, we'll hear in the near future what they think about it. But the idea is that for an upfront study in myeloma based on progression-free survival with good treatment, you need something like 1,700 to 2,000 patients.

If this is the case, then without a change in end points, it's going to be very difficult for us to continue to make the progress that we've made in the last decade [to] really [move] the treatment for myeloma patients forward, so as the majority get deep responses, prolonged progression-free and overall survivals, and their quality of life has gone up. Thank you for your attention.

Source:

Morgan G. Debate - MRD Should Guide Therapy - YES. Presented at the 2024 Great Debates & Updates in Hematological Malignancies: April 5-6, 2024. New York City, NY.