Evaluating the Potential Value of MRD as a Predictive Variable for Multiple Myeloma

At the 2023 Lymphoma, Leukemia & Myeloma Congress in New York, New York, Ajai Chari, MD, University of California – San Francisco, San Francisco, California, evaluates the potential value of measurable residual disease (MRD) as a predictive variable for multiple myeloma (MM).

Transcript:

Hi, my name is Ajai Chari. I'm a professor of clinical medicine and the director of the myeloma program at the University of California, San Francisco. 

Another topic I was asked to talk about is the role of MRD. I think we know consistently, across many studies, MRD is a good prognostic variable. The question is, can we change treatment? Can it be a predictive variable? I think the problem is we need more data. 

When we look at the clinical analytics, not every patient is analyzed. We only check MRD and suspected [complete response] (CR). The sensitivity can be 10 to the fourth or sixth, and that matters. The serial sampling is important—the fact that there's a 10% failure rate. Those are all affecting. And then, there's the clinical issue, which is that MRD-positive is not fatal. MRD-negative is not a cure. The disease matters. MRD negative in high-risk is not enough to stop therapy.

Finally, there's the prognostic predictive issue. For example, [in] the GRIFFIN study, if you're MRD-negative, you still benefited from dara[tumomab]. So, if you're going to make decisions on that, you really need prospective risk-adapted studies, which we don't have. That's why I think the health authorities are so skeptical about this as an endpoint.

In my practice, I allude to this in my talk, is the extremes. I think if you're low-risk and [are] having toxicity, and you're MRD negative, maybe consider stopping. If you're high-risk and persistently MRD-positive, maybe intensify. But, in the middle category, we really don't know what to do yet. So, we'll have to wait for data.

Source: 

Chari A. Maintenance therapy: Should CD38 ab or bispecifics be incorporated? Does MRD inform type or duration maintenance? Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-21, 2023. New York, NY