COMy 2023 | Technical tips for reliable MRD assessment in patients with multiple myeloma
Bruno Paiva, PhD, University of Navarra, Pamplona, Spain, discusses methods for reliably assessing measurable residual disease (MRD) in patients with multiple myeloma (MM). Dr Paiva highlights that next-generation flow and sequencing (NGF; NGS) techniques are highly reliable for MRD assessment and notes additional prognostic information that can be obtained by flow cytometry. Dr Paiva concludes by emphasizing the need to create new tools to identify unexpected outcomes in patients. This interview took place at the 9th World Congress on Controversies in Multiple Myeloma (COMy) 2023, held in Paris, France.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript (edited for clarity)
Here, at COMy, I have the pleasure to talk about technical tips for a reliable MRD assessment. First, I will address in whom? In which patients? And mainly it’s all about making the best of a bone marrow aspirate that is only recommended for patients achieving a negative immunofixation without forgetting that approximately 20% of patients in VGPR may also have a negative MRD and a favorable PFS...
Here, at COMy, I have the pleasure to talk about technical tips for a reliable MRD assessment. First, I will address in whom? In which patients? And mainly it’s all about making the best of a bone marrow aspirate that is only recommended for patients achieving a negative immunofixation without forgetting that approximately 20% of patients in VGPR may also have a negative MRD and a favorable PFS. Therefore, we are also recommending to consider performing MRD in patients with a prolonged VGPR and then when with the relevant time points according to the different treatment scenarios. Then how and how fortunately in myeloma it’s very clear, it’s all about following the guidelines that were proposed already in 2016 and that in my opinion, remain useful and valid for 2023. Then the methods well, I think that these days it is unquestionable that next-generation flow and sequencing are highly reliable for MRD assessment. Imaging is complementary, particularly when using PET-CT and the most important criterion is the one of sustained MRD negativity. And then once you select the methods obviously based on the resources available in the Department of Hematology, also the samples that are available, then it’s all about making the best of what the technique can offer. And at the last part of my presentation, I will focus on some of the additional information that you can obtain using flow cytometry such as the measurement of the quality of the sample to avoid the risk of severe hemodilution using flow also to characterize the patient immune status and eventually predict those that are at risk of severe infection, something more and more important with the new treatment scenarios. And finally creating new tools to identify unexpected behaviors. For example, patients that, despite a positive MRD, may enjoy long progression-free survival. And we are seeing that some, not all, some of these patients have an MGUS-like phenotype at diagnosis. And now we have created an open-access web-based calculator so that everyone can ask the question if a patient has an MGUS-like phenotype at diagnosis and these patients have favorable outcomes regardless of the depth of response achieved after frontline therapy.
Read more...
