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Minimal Residual Disease (MRD) Testing for Multiple Myeloma- Does It Matter?
Those (MM) patients who tested negative with one or both methods (positron emission tomography–computed tomography (PET-CT), multiparameter flow cytometry (MFC)) tended to do better in overall survival.
Yes, multiple myeloma (MM) patients should find out what their minimal residual disease status (MRD) is- positive or negative. The timing and frequency will depend on the patient and his/her oncologist. But, according to the interview and research linked below, MRD status can be used to determine the MMers prognosis.
The challenge is, what it means to “test” for MRD status? Confused yet?
Consider that the Patient Power interview was conducted in April of 2019. The study documenting various MRD testing methods was conducted only about three months later. The testing and understanding of MRD status is changing rapidly.
If a MM patient achieved MRD negative status, I think you should ask your MM specialist if any more chemotherapy is necessary. This is a loaded question of course, but the question is key to your long-term standing as a MM patient.
If MRD negative status means that you have one MM cell in one million normal cells, the presence of MM is tiny and therefore your prognosis may be better. More toxicity, until you relapse, may not help your progression-free survival or overall survival.
Click now to learn more about Minimal Residual Disease in Multiple Myeloma-
Have you been diagnosed with multiple myeloma? Are you confused by all this jargon aka confusing lingo? Scroll down the page, post a question or comment and I will reply to you ASAP.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- MRD Negative Plus MDR Means No ASCT in Myeloma?
- Multiple Myeloma Response Alphabet Soup- MRD, sCR, CR, VGPR, PR…
- Why a Cancer Coach?
Minimal residual disease
“Minimal residual disease (MRD) is the name given to small numbers of leukaemic cells (cancer cells from the bone marrow) that remain in the person during treatment, or after treatment when the patient is in remission (no symptoms or signs of disease)…”
Study Shows Benefit of Multiple Assessments of MRD in Multiple Myeloma
“Minimal residual disease (MRD) is considered a valuable prognostic factor for survival. MRD can be evaluated in several ways: next-generation sequencing; positron emission tomography–computed tomography (PET-CT); whole-body, low-dose CT and whole-body, low-dose magnetic resonance imaging; and multiparameter flow cytometry (MFC).
A study published in May 2019 in American Journal of Hematology looked at whether using a combination of PET and MFC to evaluate minimal residual disease (MRD) had a beneficial effect on progression-free and overall survival in 103 patients with newly diagnosed multiple myeloma.
The authors found that there was a significant difference in overall survival between groups who were negative on both PET-CT and MRD as assessed by MFC, or negative on PET but positive for MRD, versus patients who scored positive on PET-CT. Those patients who tested negative with one or both methods tended to do better in overall survival.
When Should Myeloma Patients Consider MRD Testing?
“Where do minimal residual disease (MRD) tests fit in with multiple myeloma care? Myeloma expert Dr. Elisabet Manasanch and advanced practice nurse Tiffany Richards, both from The University of Texas MD Anderson Cancer Center,give expert perspectives on appropriate timing and frequency of MRD tests. Do treatment plans change if patients don’t achieve MRD-negative status…
Andrew Schorr: “Just to be clear about the MRD testing, which becomes more and more sensitive, is that really kind of later in the process to do the MRD test? Where does it fit in?”
Tiffany Richards: “Yeah. So, usually, the MRD testing is not going to happen, until the patient is in a good remission. And so, generally, if the patient has achieved a complete remission, or if they have a small amount of residual protein, then, you may consider doing it. It really depends on the patient situation and where they are, in their journey.”
Andrew Schorr: “Okay. What about do it more than once? Do you get a remission, but then, later somebody comes out of remission? And later, would you do it again?”
Tiffany Richards: “Generally, for a patient who is not on a clinical trial, at this point in time, we may recheck it. But for the physician I work with, we, generally, won’t recheck it because, at this point in time, it’s not like we would change—so, if a patient is on maintenance, lenalidomide (Revlimid), for example, and they achieved an MRD-negative, and now, they’re MRD positive, but everything else is still looking okay, their numbers aren’t changing, we wouldn’t necessarily change treatment, at that point. And so, it’s really going to be patient dependent. Sometimes, you’ll get them once a year, but, again, we don’t necessarily change treatment because a patient went from an MRD-negative status to an MRD-positive status…”
Dr. Manasanch: “So, newly diagnosed patients, they come in. Okay, yes, we confirm this is myeloma. This needs to be treated. They get treated. The response rate for the treatment of multiple myeloma right now, with the therapist that we use at MD Anderson, the response rate is 100 percent. So, basically, everyone, maybe 1 patient in 300 doesn’t respond. So, we can say response rate is 100 percent. So, all of them are going to respond or almost all of them…
…And so, right now, the use of MRD, I think, has either been limited to when we do our bone marrow biopsies in patients after treatment and the significance is prognostic. So, overall, for most patients, if you’re MRD-negative, it’s better than if you’re MRD-positive, again, for most patients.
And that’s all that we can say right now, today, is prognosis. But in the very near future, I think that we will do things like changing treatment. Maybe we’ll do things like stopping treatment. I don’t know. But we have a lot of studies that are looking at this right now. And they will report, in the next few years. So, this is where all of this is going. And right now, MRD is limited, I think, it prognosis. If you want to know your prognosis. And then, if you’re MRD negative, and you have to have it tested every year, you can. There’s nothing against it. What do we do with the information, if it turns positive?
It’s a little bit ahead of the time where we have full answers. But it depends on the patient and the physician a lot.”