IMS 2025 | Circulating tumor DNA assessment in multiple myeloma: emerging evidence for clinical utility

At this meeting we had the opportunity to present research that has been done to understand whether we could use the circulating tumor DNA as a biomarker for myeloma patients and in particular this all started with the interest of saying can we get a biomarker for patients who have known secretory disease. Dr Wiedmeier-Nutor presented the data where she shows that actually you can detect those fragments of DNA in circulation. She’s not proposing its use specifically as an MRD test right now because what we found is if the blood is positive, usually that correlates very well with the presence of tumor burden elsewhere. If it’s negative, you can still have the disease, so it doesn’t reach the sensitivity as if you do it in the bone marrow. But nevertheless, it’s a wonderful marker to try to monitor patients and our hope is that this can be translated to the non-secretory cases. Now, the testing we did was in regular myeloma, so patients with biomarkers, because no one has a large cohort of non-secretory patients. So we wanted to see how that correlated with things like M protein, percent of cells in the bone marrow, et cetera. Now, there’s a few things that can be derived from this. One of which, which I think is pretty interesting, is that in patients who are receiving CAR-T’s or bispecifics, particularly with more advanced disease, we all have worries about extramedullary disease. So the MRD testing per se in the bone marrow, even though it’s more sensitive, may not capture the presence of disease elsewhere. So it could serve as an adjunct with some of the other protein markers, even in those that have protein, to perhaps monitor for the presence of residual myeloma.

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