IMS 2025 | Evidence supporting the use of MRD-guided treatment in multiple myeloma: GEM2014MAIN and AURIGA

So yesterday I had the pleasure of co-chairing a session regarding the application of MRD in clinical practice with Dr Benjamin Derman from the University of Chicago. So today we know that achieving MRD negativity is probably the best prognostic factor in patients with myeloma. But it’s also true that the incorporation of the use of MRD in the clinical practice is taking longer to be a reality. And so I guess we are still waiting for the results of the clinical trials that are evaluating this. So how to use MRD to take clinical decisions to improve the prognosis of the patients. But so far, I think we have a little bit or some evidence regarding the value of MRD to stop the maintenance in our patients. So the trial that we can use in that regard is the trial from the Spanish Myeloma Group, GEM2014MAIN clinical trial. So after two years of maintenance, patients. So patients that were MRD negative actually had a very, very low percentage of relapses after more than four years of follow-up. So I guess, you know, this is the group of patients. I’m not saying that this can be done in everybody, but under certain conditions, I think we have evidence that at least for sure in patients with a standard risk, after two years of maintenance, if they are in MRD negative, I think you can consider to stop the treatment with lenalidomide. So the other options are to increase the treatment if your patient has not achieved an optimal response. So I think we have less data in that regard. We can use the example of the AURIGA trial, although it’s not fully applicable to our patients because in the AURIGA trial, patients were not treated with a quadruplet as induction. But the authors showed that actually, if you use an optimal or a better regimen as a maintenance and you induce a higher percentage of MRD negative cases before maintenance or during maintenance, so this group of patients reaching MRD negativity with a better combination, as usual, have a better outcome. So we have some evidence regarding the value of MRD to reduce the treatment. We have initial evidence regarding the value of using MRD to optimize the treatment. As I said, so initial evidence not fully applicable to the routine clinical practice. And I think we need to gather more evidence regarding the value of MRD in those cases in whom we see MRD resurgence. So this happens, so patients reach MRD negativity and then the disease can come back in the form only of MRD positivity. And in those cases, I think we need more evidence to take clinical decisions based on that because the prognosis of those patients is very heterogeneous. So we need to gather more information to take more informative clinical decisions about those patients. So I think this will come in the next few years, but we are still waiting for more evidence, for more studies to support us to take the corresponding clinical decisions based on these results.

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