IMS 2025 | MRI response and its correlation with MRD negativity after induction in NDMM: the GMMG-HD7 trial

So minimal residual disease assessed in the bone marrow is currently the gold standard when it comes to assessing the depth of treatment response in patients with multiple myeloma, but as we know, myeloma can be a very heterogeneous disease, so with MRD, we just have one assessment of one sample of one body site. So in the GMMG-HD7 imaging sub-study, we conducted whole-body MRI scans at baseline and after induction, as well as MRD assessing the bone marrow by next-generation flow cytometry after induction. We included 83 patients in this sub-study, and the MRI assessments were done according to the MY RADS protocol. This is a standardized and structured reporting system for whole-body MRI in multiple myeloma, and it scores diffuse infiltration, the size and the number of focal lesions, as well as the presence and absence of extramedullary disease. What we observed was that patients with lower scores of diffuse infiltration after induction were much more likely to achieve MRD negativity. And what I found very interesting was that the MRI scores at baseline alone weren’t predictive of MRD status. But if you see this in a dynamic context, so if you take into account if the patients are decreasing MRI scores, then the correlation became significant. So patients who had a decrease in their MRI scores achieved MRD negativity much more often. And in this context, baseline scores also become important because the group with the patients who had lower MRI scores at baseline as well as a reduction in their scores were the group with the highest possibility of achieving MRD negativity. So I think MRI, a whole-body MRI combined with MRD status, would be a very important tool in the next years for risk stratification and decision-making when it comes to therapy in multiple myeloma.

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