COMy 2019 | MRD and outcome after transplantation

Bruno Paiva

Determining MRD status has become an invaluable tool in the transplant setting. Here, Bruno Paiva, PhD, of University of Navarra, Pamplona, Spain, discusses the improvements in measuring MRD status and the impact that this has had. Furthermore, Dr Paiva highlights some improvements still to be made in the field, such as the ability to maintain an MRD negative status in patients and how we may be able to achieve this. This interview took place at the Controversies in Multiple Myeloma (COMy) 2019 World Congress in Paris, France.

Transcript (edited for clarity):

Well, this morning I gave a talk about the role of MRD in the transplant setting. A lot of data has been accumulated in recent years and we have witnessed really remarkable improvement in the way we measure MRD and also in the quality of the data. Whereas, in the past the methods that we were using were perhaps not as sensitive, and even though there was a clear role for MRD in discriminating true CR from false CR that was more likely a partial response.

Nowadays, we are seeing that the impact of achieving an MRD negative result is remarkable in two different studies using different technologies, both studies in transplant eligible patients. We are seeing that achieving an MRD negative result translates into approximately 80% in the reduction of the risk of progression and/or death. While this is remarkable and I think it has been great achievement there is still a lot to be done, particularly strategies to better monitor and also patient management regarding maintaining an MRD negative status because we are seeing that even though patients may achieve an MRD the negative result down to 10-6 with the best technology.

Some patients continue to relapse, some with or without extra [inaudible] disease and this points to the fact or to the urgency of combining either NGF or NGS with PET CT and also to repeat the test often because this will minimize the chances of a false negative result.

In summary, great achievement improvement we are seeing very promising results in the setting of higher risk in patients with higher risk [inaudible] genetics for which achieving MRD negativity aggregates the prognosis of high-risk cytogenetic abnormalities but also the same time seeing that is important it is to achieve an MRD negative result is to start to sustain otherwise there is still some risk of relapse.

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