Minimal residual disease analysis in myeloma – when, why and where

Abstract

The primary hurdle in the path to curing multiple myeloma (MM) is defining a validated minimal residual disease (MRD) and its utility in the therapeutic decision making. A better definition of MRD will aid in tailoring MM therapy further to address the clonal heterogeneity and genomic instability and overcome patient’s ineffective immune surveillance. MRD analysis can define the logical endpoint for maintenance therapy, in addition also aids in providing a better clinical end point for studies comparing novel agents in myeloma. MRD is a surrogate for the survival in MM. Guidelines for global incorporation of MRD in myeloma are fraught with lack of standardization, universal availability and abridged physicians’ understanding of MRD modalities. We aimed at addressing some of the frequently asked questions in the MRD assessment and will also place in perspective some arguments in favor of MRD assessment in routine practice and clinical trial scenario.

Keywords:

• Multiple myeloma
• survival
• response
• residual disease
• flow cytometry
• sequencing
• imaging

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1386304.

Additional information

Funding

Shaji Kumar: Celgene (Consultancy and Research Funding), Millennium (Consultancy and Research Funding), Novartis (Research Funding), Onyx (Consultancy and Research Funding), AbbVie (Research Funding), Janssen (Consultancy and Research Funding), and BMS (Consultancy and Research Funding).