Should Minimal Residual Disease Guide Therapy for Patients With Multiple Myeloma?

At the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in Los Angeles, California, Murali Janakiram, MD, MS, City of Hope, Duarte, California participated in a debate about the value of minimal residual disease (MRD) in the treatment and management of multiple myeloma therapy.

Transcript:

Hi, my name is Murali Janakiram and I'm coming live to you from LA at the Great Debates and Updates in Hematological Malignancies meeting. My topic today is that MRD is not ready for prime time. MRD, or minimal residual disease, is a great test and it is going to change, or it is changing, the field of myeloma. But the question really we are asking is: is it good to go to the community and say, do this test and we can impact the results of patients?

I think to some extent it is good because there is enough evidence to do an MRD test at 2 years in standard-risk patients and stop therapy. But is there enough evidence for me to continuously monitor MRD and change treatment because of that? Not at this time.

That is the reason why I took the stance that MRD is not yet ready for prime time except in selected patients. Let me give you some examples. We have someone who is MRD-positive and we give good treatment, and they are still MRD-positive. What do we do? Do we keep escalating treatment? We don't know the answer. We really need more data.

Very similarly, if someone is MRD-negative and they are slightly starting to become MRD-positive, do we change, or just leave these patients as such? I think all these questions are going to be answered in future trials, in the next generation of clinical trials which is coming up.

Until then, it is very difficult to recommend MRD use and interpretation in routine community practice in oncology. It is certainly a good test. It is certainly the future of the field. But at this time, it is useful only in a select subset of patients at this point of time. And that is the stance of this debate. Thank you.

Source:

Janakiram M. Debate: MRD Should Guide Therapy – No. Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; July 27-28, 2024; Los Angeles, California.