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Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

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Does MRD Make Auto Stem Cell Transplant Obsolete in Multiple Myeloma?

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“However, it is now urgent to define and incorporate MRD into our response criteria more generally, since combination novel therapies, with or without autologous stem cell transplant (ASCT), can now achieve MRD”

Dr. Ken Anderson doesn’t come out and say that multiple myeloma (MM) patients achieving minimal residual disease (negative) status post induction therapy, can eliminate the need for further toxic treatment. But his article leads the reader to that conclusion.

After all, only one of the most senior, world-renown, experienced MM specialists could question the need for a standard-of-care therapy that costs hundreds of thousands of dollars, causes extensive short, long-term and late stage side effects yet does not add to the overall survival of multiple myeloma patients.

Question-if you reached MRD (negative) status after 4-6 rounds of induction therapy and you read a study confirming that additional chemotherapy, on average,  would not increase your overall survival, would you then have an autologous stem cell transplant?

Further, according to Dr. Anderson below, novel therapies make it possible for relapsed MM patients to achieve MRD.

To be clear, achieving MRD negative status requires aggressive chemo. I’m not saying for a minute, that achieving MRD is easy. But the day may come when studies compare quadruplet induction to an ASCT and conclude that the novel therapies cause less damage and cost less money.

Have you been diagnosed with multiple myeloma? What are your symptoms? Your stage? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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Should minimal residual disease negativity be the end point of myeloma therapy?

“Traditionally, complete response (CR) in MM has required absence of monoclonal protein by sensitive immunofixation techniques and normalization of the BM. This definition was then refined by the IMWG to stringent CR, which also required a normal κ:λ ratio.

Importantly, due to the unprecedented depth of responses now achievable with novel therapies with or without high-dose therapy and transplantation, the IMWG has most recently further defined the consensus criteria for response and minimal residual disease (MRD) response assessment.

In the setting of conventional CR, absence of detectable MM using either next-generation flow cytometry or by next-generation sequencing (both with a sensitivity of detection of 1 in 105 nucleated cells or better) now defines flow or sequencing negative MRD, respectively.

By IMWG criteria, sustained MRD negativity requires 2 such determinations 1 year apart. Finally, an imaging MRD-negative response in addition requires resolution of all areas of increased tracer uptake on positron emission tomography/computed tomography scan…

Until recently, MRD negativity was obtainable primarily in the context of allogeneic stem cell transplantation, where sustained MRD negativity due to a donor graft-versus-MM effect is associated with long-term disease-free survival and cure.

However, it is now urgent to define and incorporate MRD into our response criteria more generally, since combination novel therapies, with or without autologous stem cell transplant (ASCT), can now achieve MRD…

For example, in the Inter-Groupe Francophone du Myelome and Dana-Farber Cancer Institute (IFM/DFCI) clinical trial of lenalidomide, bortezomib, and dexamethasone induction therapy with or without early ASCT followed by 1 year of lenalidomide maintenance, 80% and 60% patients achieved MRD with or without early transplant, respectively.

Importantly, this study further showed that MRD status after maintenance therapy was associated with PFS and suggested a threshold of sensitivity of 10−6 to define MRD negativity.

Excitingly, daratumumab in combination with either lenalidomide or bortezomib and dexamethasone can achieve MRD even in relapsed disease.,

MRD negativity was associated with improved PFS and OS, both overall (P < .001) and in patients who were in CR (P < .001). Although there was some overlap in the clinical studies included in the second meta-analysis, Landgren et al similarly found a statistically significant correlation between MRD negativity and both PFS (P < .001) and OS (P < .001)…

 

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