Negative MRD (measurable residual disease) is a powerful predictive factor in multiple myeloma (MM). The limited viability of MRD testing, however, has hindered the best use of MRD in routine clinical practice. Therefore, in newly diagnosed MM patients who underwent autologous stem cell transplantation (ASCT), researchers investigated the clinical relevance of commercially available MRD modalities based on clonality assays by fragment analysis with IdentiClone® (n=73 patients) and next-generation sequencing (NGS) with LymphoTrack® (n=116 patients).

At the conclusion of induction (pre-ASCT) and/or 100 days following ASCT, MRD was evaluated (post-ASCT). When evaluated by fragment analysis, MRD was unable to predict survival. However, progression-free and overall survival benefited with NGS-based MRD negative at pre- or post-ASCT.  Additionally, patients with MRD positivity both pre-and post-ASCT had the poorest prognosis. MRD negative determined by NGS was independently linked with increased progression-free and overall survival. In fact, after NGS achieved MRD negatives, the original negative prognostic characteristics of high-risk cytogenetics may be reduced.

They showed that attaining MRD negative with commercially available clonality-based MRD tests in MM is feasible and clinically advantageous. They further suggested using NGS, but not fragment analysis, to customize therapy approaches in actual clinical settings.

Reference: onlinelibrary.wiley.com/doi/10.1111/bjh.18211