ASH 2022 | Investigating quadruplet therapy & MRD-guided treatment outside of clinical trials in NDMM

So at the meeting, my colleague from UAB, Dr Gayathri Ravi, is presenting an interesting poster with an academic community partnership employing quadruplet therapy and MRD response-adapted therapy. I think by now we’re all familiar with quadruplet data that comes mostly from clinical trial settings, MASTER, GRIFFIN, CASSIOPEIA, and so forth. And the notion of MRD has been really solidified in the context of clinical trials. I think there’s still some reluctance and some slowness into adapting MRD as part of routine practice. So what we did a few years ago at UAB, we have our own consensus of how we treat patients with newly diagnosed myeloma, particularly the ones that are eligible for transplant. And based on our own experience and on available information, we made MRD assessment by next-generation sequencing as being a part of that element. So we do something very similar that we did on MASTER, patients use quadruplet therapy, usually with dara-VRd for that being a more recognized regimen, particularly by payers.

We assess MRD pre-transplant, MRD post-transplant, and based on MRD, we make a recommendation for additional consolidation, and if patients have confirmed MRD negativity to cease therapy and observe the patients. So I think the most important point is that’s feasible. Many of those patients get treated at UAB. Many of those patients get treated in the community. Our partners in the community are very supportive and the idea of using depth of response to modulate therapy resonates very easily with patients, it resonates very easily with other physicians. So even though this is not in the context of a clinical trial, we’re able to obtain MRD assessment in over 80% of the patients. We achieve a little bit over 20% of MRD negativity pre-transplant, more than 50% post-transplant with numbers that are very close to what was obtained, for example, in GRIFFIN with dara-VRd, even though those are less selected patients, not as fit for therapy as they may have been those patients in GRIFFIN. So essentially a testament that quadruplet therapy and MRD-guided treatment adaptation is feasible outside the context of clinical trials.