Miami Myeloma MRD 2025 | Clinician & patient perspectives on the value of MRD in myeloma: what should patients know?

Joseph Mikhael

Hello everyone and welcome to the Miami Myeloma MRD meeting 2025. My name is Dr Joseph Mikhael. I have the privilege of being the Chief Medical Officer of the International Myeloma Foundation and a Professor at City of Hope. And joining me today is a dear friend and a patient who I’ll allow to introduce herself.

Jenny Ahlstrom

My name is Jenny Ahlstrom and I’m a multiple myeloma patient and the CEO and founder of the Health Tree Foundation.

Joseph Mikhael

Well, Jenny, it’s great to have you here and it’s great to be at this meeting. This is a meeting we’ve had for several years virtually. It’s really nice to be in person, although I understand we have over 800 people who’ve also joined us virtually. And perhaps more than ever is this an exciting time in the world of MRD or minimal residual disease because, in fact, when this meeting was first created, the thought was, let’s have this meeting until we get word from the FDA that MRD can be an endpoint in clinical trials. Sure enough, that happened last year with that incredible ODAC vote, 12-0, supporting MRD as an endpoint to be used for accelerated approval and trials. But the meeting still goes on because if maybe there’s been a theme that I’ve picked up at this meeting has been that we’re not done yet. We still have so much more to learn about MRD and to start to implement it, but I’d love your thought and take on sort of where is MRD today and specifically how it influences the patients that are watching.

Jenny Ahlstrom

Well, it’s interesting because the most common question we get about MRD testing is, when can I stop therapy for patients? So they wanna know, what does MRD mean, first of all? Some do and don’t know. What does it mean for me in terms of my care? Does it mean I need to stay on treatment? Does it mean I can stop treatment if available? And as we’ve heard from this meeting, this is one more very important data point that goes into the whole analysis in this shared decision-making between patient and doctor about what you do next in your care. So it’s been fascinating to see, well, it’s been impressive to see the FDA approve this because that means faster drug development for new drugs to come to patients.

Joseph Mikhael

Yeah, I think that’s actually critical. I wanna emphasize that point for a minute, because what people may not understand is, historically, to get a drug approved, it would obviously be tested, and we do all the work we do in the lab, and then we may do it in mouse models, and eventually it comes to a Phase I trial, eventually to a Phase II trial. That ultimate approval requires that progression-free survival and ultimately overall survival advantage, which in some ways now is a good problem that we have in myeloma, that we have such great drugs that it takes that long. But the whole concept of this ODAC meeting and the whole concept of MRD being a biomarker, or if you will, a predictor of what’s going to happen later, that we don’t have to wait until that progression-free survival is evident by the depth of response with MRD negativity. That could now allow a faster accelerated approval of drugs. And that’s what’s so exciting because we don’t want to wait another seven, eight, 10, 12 years for the next drug to be approved.

Jenny Ahlstrom

No, we can’t. I mean, we’ve seen this acceleration in myeloma therapies come out. And I think, you know, 2014 really kind of launched a whole host. Now, a lot of immunotherapies are coming out. And it’s like you said, this amazing blessing that patients are living so much longer, but we don’t want to wait 10 years for a trial to read out because by the time it reads out, it’ll be obsolete anyway. So let’s use all the tools in the toolbox and let’s use these newer methodologies.

Joseph Mikhael

And so on that theme of tools in the toolbox, that’s something else I’ve really taken from this meeting, which is that, you know, MRD is not just about getting faster drug approval. That’s clearly one of its features, but it also now is reaching a point where it’s not just an endpoint in a trial. It really is starting to influence the way we think about how we’re going to treat patients. We’re not, I guess, quite ready to say, oh, if you’re MRD for this long, then absolutely you can stop treatment. It’s not a yes or a no phenomenon, but it is a piece of information that may influence our de-escalation of therapy or tapering down therapy or possibly needing to change therapy. So from your perspective, and both of us obviously work directly with patients all the time, what do you want patients to know? What should they be saying to their doctors about MRD testing?

Jenny Ahlstrom

Well, get the test.

Joseph Mikhael

Okay. I wasn’t trying to lead the witness, Your Honor. I mean, that’s exactly the point.

Jenny Ahlstrom

I mean, this is what I wanted when I was first diagnosed. I wanted to be able to say, how do you personalize care for me as a patient? And you’re going to do that. You know, precision medicine came out and it was very popular about 10 years ago. We all thought it was about just genomics, but it’s not just about genomics. It’s about what genetic features do you have and in what combination and how do you respond to therapy? Do you relapse quickly? Do you relapse in a delayed sort of way? And with what treatment combinations? So we don’t really get to myeloma cures until we have sufficient data to be able to pull all these data points together and then start seeing patterns across different types of patients that look similar. So to me, this is one more data point that is really critical for me to get treated as a patient more personally.

Joseph Mikhael

Yeah, I love that. I used the analogy in the meeting today, I always say to patients that myeloma is like a crime scene. It has all these points of information and not one thing tells you the whole story. But what we’re learning today at this fantastic Miami Myeloma MRD meeting is that it is a really important piece of information and it can be used correctly. We want patients to be excited about it, but we also want to make sure that it’s not just MRD or bust. We’ve been discussing the nuances of when it may not be quite as helpful or when we may have to repeat it. And I think that’s the phase we’re going into. And as we wrap up this discussion, I’d love your thoughts about sort of the future of MRD. Like, where are we going, even from a patient’s perspective? I know how much you love getting those bone marrow tests. You know, are we going to be able to do it by blood? Or what do you see for the future?

Jenny Ahlstrom

I mean, I think understanding the depth of disease, it seems like the tools are evolving. We’re getting these more sensitive tests, like this MRD testing that we never had before. and other tests are coming out. Blood-based is ideal for patients. Obviously, we don’t want to have to go through a bone marrow biopsy, but let’s make sure that it’s just as accurate as a bone marrow biopsy form. But if we have blood-based tests, then it’s so much easier to follow. You know, you can do a monthly or a quarterly type of test and really know what’s happening with the disease as you move along instead of just guessing or waiting or doing it once a year because it’s so intrusive. So I think it’s headed that way. I hope it’s headed that way and I’m very excited about that.

Joseph Mikhael

I hope so too. And even now, you know, it’s being incorporated into so many clinical trials. A lot of these trials are including that kind of modality so that we can prove that maybe we can do it. And I think likely for the majority of patients, we will be able to do it in blood. There are some forms of myeloma that just, if you will, hide out in the marrow a little bit more and we may have to use that in some. But it speaks to the complexity of the disease. And I actually think MRD is teaching us more about myeloma and how myeloma behaves and how it treats. But these are exciting times. And it tells me that we’re going to have to have a Miami myeloma MRD meeting 2026 and beyond, because it really is the start of an era, not really the end of an era.

Jenny Ahlstrom

Yeah. And I think one thing that patients need to know is that many patients, over 80% of myeloma patients are being treated in the local oncology clinic. So this may be a test that you need to ask your doctor about because they might not bring it up. Because some of the general oncologists are saying, well, I’m not sure exactly yet what I’m going to do with that result. The academic doctors like yourself are more adept at understanding how to use that information for treatment purposes. But unless you gather the data, you’re never going to know. So this is something you should ask your doctor about.

Joseph Mikhael

Absolutely. Spoken by the data queen, as I have called you before. Even if it’s not gonna immediately change management, it’s gonna be a piece of that puzzle to help with time. Well, thank you so much for joining us today. We hope this has been helpful to you. Whether you’re coming today as a patient, trying to understand MRD a bit more, what it means to you, or a provider and how you use it, we have come such a long way. This is our first meeting since that wonderful ODAC approval. And as we’ve discussed today, this is a very powerful tool that we think we’ll be implementing more and more in the clinic in the days to come. Thanks again for joining us.

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