Advancing Myeloma Treatment With Blood-Based MRD Testing

In season 5, episode 3 of Targeted Talks, Ben Derman, MD, assistant professor of medicine at the University of Chicago Medical Center, dissects the latest advancements in myeloma treatment, focusing on the role of ClonoSeq and minimal residual disease (MRD) monitoring.

Specifically, the discussion delves deep into the game-changing trial (NCT02969837) investigating MRD in the peripheral blood of patients with multiple myeloma. An analysis of the study recently evaluated the concordance and prognostic significance of early MRD status after 4 cycles of treatment with elotuzumab (Empliciti), carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (Elo-KRd) by next-generation sequencing in the bone marrow and peripheral blood and by International Myeloma Working Group response criteria. Findings were presented at the 2023 American Society of Hematology Annual Meeting.

"Peripheral blood testing, while not as sensitive as bone marrow, could offer a less invasive alternative for patients, potentially guiding treatment decisions more effectively," Derman explains.

The trial employed an MRD-adapted design to determine the duration of carfilzomib treatment based on MRD status, demonstrating a personalized treatment approach guided by MRD assessment.

Pivotal findings from this trial showed the association of peripheral blood MRD status with progression-free survival (PFS). Patients with peripheral blood MRD positivity exhibited inferior PFS outcomes compared with those with peripheral MRD negativity. The strong correlation between bone marrow and peripheral blood MRD status indicates the potential utility of peripheral blood MRD testing as a reliable indicator of disease burden and treatment response.

These findings underscore the transformative potential of peripheral blood MRD testing in the management of multiple myeloma, paving the way for personalized treatment strategies and improved patient outcomes.

Gain more insights into the exciting advancements in MRD detection, including next-generation sequencing and mass spectrometry, offering patients a less invasive alternative for monitoring disease progression in this episode.

REFERENCE:

1. Derman BA, Kubicki T, Simmons H, et al. Early peripheral blood minimal residual disease status by NGS in patients with newly diagnosed multiple myeloma (mm) on a phase 2 trial receiving elotuzumab, carfilzomib, lenalidomide, and dexamethasone (Elo-KRd). Blood. 2023;142(Suppl 1):1982. doi:10.1182/blood-2023-182410