Miami Myeloma MRD 2025 | MRD as an early endpoint for accelerated approval in myeloma: current perspectives & future outlooks

Ola Landgren:
Hi, I’m Ola Landgren. I’m a professor of medicine, and I lead the myeloma program at the University of Miami. I’m here today in beautiful Miami at the Miami Myeloma MRD meeting of 2025. I’m here together with my long-term friend and colleague, Dr. Dickran Kazandjian. We work closely together at the University of Miami. We are just about to kick off the meeting here, and there are a lot of new things in the field of MRD for myeloma. The reason we started this meeting over 10 years ago was really to push it over the goal line to the FDA and make MRD a regulatory endpoint. A lot of people told us that’s never going to happen, it’s not a good idea, but we actually delivered that last year. So, what are your perspectives on this, Dickran?

Dickran Kazandjian:
I think it’s wonderful. I think it shows how persistence kind of pays off and is important. I mean, I think it’s been about 15 years we’ve had these meetings, and sometimes meetings feel like they don’t go anywhere, but actually, this is the proof of principle where if you keep pushing on, if you keep making friends, collaborators, and work towards the same goals—and really, our goals are all the same—and that’s to provide better care for our patients and really decrease their suffering at the end of the day, and as you mentioned MRD is an important key piece in that. And so, to actually see that come to fruition, I think is wonderful. I mean, it’s been wonderful for my own career to be part of it and to grow up with it.

Ola Landgren:
I share exactly the same perspectives. And I think that for people that listen to this that are maybe in the beginning of their career, to me, an important message is, if you work on something that you believe is important, don’t give up, because people will usually tell you it’s not a good idea, it doesn’t work. But if you believe in it, keep on working on it. And I think if it’s related to patient care, it’s related to outcomes, if you see there is a path forward, these are the important things you need to really stand up and work for. And that’s what we have done together. I think still, there are a lot of things that we need to do in addition, after the FDA approval that you pointed out here before we started filming, is actually the annual anniversary of today, right?

Dickran Kazandjian:
Right, it’s a celebration, actually, because it’s been one year since that, and it’s the first time that we actually come back together as a group and really discuss where our momentum is going to take us for the next steps altogether.

Ola Landgren:
Yeah, so a whole year has passed, but we are now here together, actually, for the first time in a virtual hybrid environment where we have almost 1,000 people registered online. We have almost 100 people here at the meeting in Miami. So, we are now united here after the FDA approved MRD as an early endpoint for accelerated approval a year ago on this day. Questions I think are important going forward are how can we use MRD to develop a cure for myeloma? We don’t yet have an established cure. And I would envision that if we have the best therapies, if we can really make sure there is no disease left behind in the individual patient, that could be a path towards the cure. I also think that MRD can play an important role, and it already does, to steer the therapy for individual patients. You can increase or decrease intensity. You can even forego certain steps. You can forego additional combination therapy cycles. You can forego transplant. You can forego combinations or maintenance. You can go down to less intense maintenance or so many things you can do.

Dickran Kazandjian:
No, absolutely. I mean, I think our drugs are getting really good, and it’s wonderful to see high response rates, MRD-negative rates, progression-free survivals, but we also have to sort of accept the elephant in the room that we are over-treating a small, small percentage of patients. And MRD could be the tool to actually guide which patients actually need more therapy. And one day, it could also be sort of, you know, guide what type of therapy in terms of mechanism of action or other things.

Ola Landgren:
I agree with that. And MRD, as you point out here between the lines, that MRD could be viewed as positive, negative, but there is information also for guiding therapy—what type of cells are left behind. Maybe MRD will give information on targets. So, we could think of MRD as a more sophisticated tool in the future and a lot of technologies. And that really takes me to think about another important thing I think with this meeting is really to talk about technology because technology will always get better. And I think having blood-based tests, having tests that can maybe be imaging-based and other types of technologies and to drive the field forward in a united way, I think that’s an important task for this meeting going forward.

Dickran Kazandjian:
Yeah, no, I agree. I mean, I think there’s no question MRD is an earlier marker we can use to do all these changes in the patients, but now the next step is, how do you do it so that you can check MRD as often as you want without causing significant morbidity in terms of the procedure for the patient.

Ola Landgren:
I’m really very excited. We were just about to kick off the meeting here. Are you ready?

Dickran Kazandjian:
Me too, yeah, I’m ready. Let’s do it. Let’s go.