- Country: Australia
- Official Title: Professor
- Department: The Malignant Haematology, Transplantation and Cellular Therapies Service
- Institute: The Alfred Hospital
Speech Title
MRD-driven MM Treatment
The emergence of more effective therapies for multiple myeloma (MM) has necessitated the repeated revision of response criteria for MM as patients have achieved deeper responses. The current IMWG response criteria defines minimal residual disease (MRD) negativity as fewer than 1 MM cell in 105 bone marrow (BM) cells (<10-5), measured by either next generation sequencing or next generation flow. Multiple studies have unsurprisingly and consistently demonstrated superior progression free survival (PFS) for those patients achieving MRD negativity when compared to those who have not. MRD negativity is therefore a more rapidly identifiable surrogate of PFS, with implications for the more rapid attainment of clinical trial survival end-points and potentially earlier drug approvals. Importantly MRD has been recently approval by the FDA ODAC. Against this background, peripheral blood(PB)-based MRD strategies utilising a range of mass spectrometric approaches have been developed and evaluated, thus overcoming the significant shortcomings of BM-based MRD testing, namely the invasive nature of the approach and it’s failure to accommodate the intra and extramedullary spatial heterogeneity of MM. Based on observations to date, it is likely that within the next decade routine BM MRD testing in MM will be supplanted by PB MRD testing and radiological imaging.