Using Minimal Residual Disease (MRD) in Clinical Practice

Jim Omel |

Each year as ASH begins the Blood & Marrow Transplant Clinical Trials Network (BMT CTN) Myeloma Intergroup meets to improve treatment approaches related to transplantation in multiple myeloma. This group, representing all significant transplantation centers, discussed incorporating minimal residual disease (MRD) testing to better serve patients. These are some of the questions they reviewed.

Questions About Minimal Residual Disease (MRD) from the American Society of Hematology annual conference 2018

Questions from the BMT CTN Myeloma Intergroup on minimal residual disease (MRD)

 

    • It’s obvious that MRD negative status has prognostic value, but how can we further use this tool?
    • Can we base treatment decisions such as stopping, starting, or changing therapy on MRD negative or positive status?

The consensus is that this is still a work in progress. We also need a reliable peripheral blood test instead of relying on frequent bone marrows.

The current status of MRD in any given patient is not a constant. Like myeloma itself, this test result can change over time, something referred to as MRD Kinetics.

Minimal Residual Disease (MRD) Status During Maintenance

The concept of MRD Kinetics is illustrated by this graph.

If we are to utilize MRD testing to guide treatment, fluctuating MRD status certainly complicates the matter.

As much as we patients want faster and easier answers, we must accept that this technology takes time for development and proof of value. MRD testing has significant promise. We must learn over time how best to use it.

 

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