IMW 2021 | Should MRD-adaptive approaches be used in myeloma treatment?
Fredrik Schjesvold, MD, PhD, of the Oslo Myeloma Center Oslo University, Oslo, Norway, shares his views on whether measurable residual disease (MRD) should be used to guide the adaptive treatment of multiple myeloma. Dr Schjesvold describes three ways in which MRD could influence treatment approaches: to intensify the treatment of patients who don’t become MRD-negative with initial treatment, to lower the intensity of treatment in patients who achieve MRD-negativity, and to treat relapse patients earlier. Dr Schjesvold also talks on the current limitations of MRD-adaptive approaches citing the need for further studies and research demonstrating the benefits of MRD-adaptive approaches in the treatment of multiple myeloma. This interview took place during the 18th International Myeloma Workshop (IMW 2021) congress.
Transcript (edited for clarity)
The short answer is, “No, not at the moment”. MRD status has shown great prognostic value, and it’s sort of enticing us to think should we guide treatment by this non prognostic value? And that could be done mainly in two, maybe three ways. One is to intensify treatment in patients that do not become MRD-negative. One other option is to de-intensify treatment in patients who achieve MRD-negativity...
The short answer is, “No, not at the moment”. MRD status has shown great prognostic value, and it’s sort of enticing us to think should we guide treatment by this non prognostic value? And that could be done mainly in two, maybe three ways. One is to intensify treatment in patients that do not become MRD-negative. One other option is to de-intensify treatment in patients who achieve MRD-negativity. Now today, we just treat patients the same, with the same long-term approach to treatment. In the future, we might intensify treatment in MRD-positive and de-intensify MRD-negative. And the third way of using MRD is to treat relapse from MRD-negativity earlier when they become MRD-positive.
So, I think these are all reasonable options, but the bottom line is that we need to have studies show that this is the right way to move forward. That means that if you want to intensify treat in MRD-positive, you need to know that that actually benefits the patient, and doesn’t just give more side effects, more toxicity, and that you want to de-intensify MRD-negative patients. You need to know that this is actually good for the patients and not depriving them of good long-term treatment. And with relapse treatment, you need to show that it actually benefits the patients to start relapse treatment earlier instead of having less treatment and less toxicity while waiting for the progress of the disease we today treat. So, I think that they are very good for a prognosis, but not to guide treatment.
However, there are, as I will show in the talk, many studies trying to answer these questions. So, in the coming time, we will eventually get the results from these treatments and know more certain that to guide treatment by MRD results will be beneficial for the patients, and hopefully it will because I think it will, if it turns out as we want and expect, I think the results might be better for all patients when we guide treatment by MRD status. But today, I don’t think we have the data to do that.
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