COMy 2022 | The benefit of using MRD to guide treatment decisions in multiple myeloma
In this video, Bruno Paiva, PhD, University of Navarra, Pamplona, Spain, shares some insights into the pros and cons of using measurable residual disease (MRD) to drive therapy in multiple myeloma. Dr Paiva explains some arguments against the use of MRD, and then goes on to discuss why MRD is the most relevant prognostic factor and a valuable tool for guiding treatment decisions. To conclude, Dr Paiva discusses some data from clinical trials which further support the use of MRD to guide therapy in myeloma. This interview took place at the 8th World Congress on Controversies in Multiple Myeloma (COMy) 2022, held in Paris, France.
Transcript (edited for clarity)
I’m Bruno Paiva from the University of Navarra in Pamplona, Spain. At COMy, we discussed about the pros and cons of using MRD to drive therapy. I think that an argument that is commonly used against using MRD or testing for MRD is the lack of clear guidance on how to use MRD for treatment decisions. And while this may be true, in 2022, I think that such an argument is not valid, because if we only test for those markers that have clear indication for treatment decisions, then there will be literally no markers to test for in myeloma, because perhaps with the exception of patient frailty, age and a few other disease-related factors, other biomarkers such as cytogenetics, imaging, response to treatment, most often are not used for treatment decisions...
I’m Bruno Paiva from the University of Navarra in Pamplona, Spain. At COMy, we discussed about the pros and cons of using MRD to drive therapy. I think that an argument that is commonly used against using MRD or testing for MRD is the lack of clear guidance on how to use MRD for treatment decisions. And while this may be true, in 2022, I think that such an argument is not valid, because if we only test for those markers that have clear indication for treatment decisions, then there will be literally no markers to test for in myeloma, because perhaps with the exception of patient frailty, age and a few other disease-related factors, other biomarkers such as cytogenetics, imaging, response to treatment, most often are not used for treatment decisions. However, MRD status is the most relevant prognostic factor in myeloma. And therefore, it is a piece of information that is crucial to have, to predict what would be patient’s outcome.
Simultaneously, I believe it is important to better define patients that, because of a unique biology, may not need to achieve a deep response to treatment to enjoy prolonged survival. And we are working on that. For example, the definition of an MGUS-like phenotype that is associated with excellent progression-free survival, regardless of depth of response, and also eventually immune profiling. From a clinical point of view, it is true that treating persistent MRD is not abrogating the poor prognosis of persistent MRD, but I believe that this may be a window of opportunity for newer immunotherapies to eradicate the MRD clone.
Finally, new data from randomized clinical trials is suggesting that eventually in patients with standard or only a few high-risk cytogenetic abnormalities, you may stop treatment on the basis of consecutive sustained and high sensitive negative MRD. And eventually, 85% or more of the patients will be disease-free and also treatment-free for a period of three, four years. Therefore, I think these are preliminary but positive results about the role of MRD for treatment decisions in myeloma.
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