What I wish I knew about Multiple Myeloma treatments 25 years later...

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“MRD is the Goal in Multiple Myeloma” Dr. Raphael Fonseca

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…at the time you start therapy, I think the aspiration should be for (MM) patients to get to MRD-[negative] status. Dr. Raphael Fonseca”

Every therapy, every drug for the treatment of multiple myeloma (MM) comes down to one thing. Killing as many MM cells as humanly possible. MM patients endure untold pain and suffering (side effects) all to achieve this one goal. Kill my MM! According to Dr. Raphael Fonseca, MRD neg. status is the goal in multiple myeloma.

The diagnostic result called “minimal residual disease” is the newest test that can measure the amount of MM in the patient’s body. If the patient is MRD negative, he/she records just one MM cell within 1 million bone marrow cells. That’s one sensitive test measuring a tiny amount of MM…

And why do we go through hell in hopes of killing our MM so thoroughly? We do this because research has shown us that MM patients who reach MRD neg. status are likely to live a longer progression-free survival and perhaps even a longer average overall survival. MM is incurable so all we can hope for is the longest overall survival possible.

According to Dr. Fonseca “MRD is being used to determine the depth of response, as providers try to get patients to an MRD-negative state.” Depth of response could be to an autologous stem cell transplant, or response to maintenance therapy or even the depth of response to induction therapy.

Granted, MM patients who reach MRD neg. status after only their induction therapy may not be a huge percentage of patients, but there will be some.

So according to Dr. Fonseca, MM patients who reach MRD negative status after their induction therapy don’t need to also undergo an ASCT, saving the patient time, money and further adverse events!

I can’t help but wonder if evidence-based but non-conventional, non-toxic therapies that are cytotoxic to MM can then serve as long-term maintenance therapy? After all, I’ve managed to remain MM free since I reached complete remission in 4/99. Food for thought.

Have you been diagnosed with MM? 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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The Increasing Relevancy of MRD Testing in Blood Cancers (MM)

“Minimal residual disease (MRD) testing is increasingly being used as a diagnostic and monitoring tool in hematological cancers (MM). Some consider MRD testing as the future…

Primarily, MRD testing through flow cytometry and next-generation sequencing is being done in academic centers or centers that practice stem cell transplantation, noted Rafael Fonseca, MD, a hematologist at the Mayo Clinic Cancer Center in Arizona.

He explained that MRD is being used to determine the depth of response, as providers try to get patients to an MRD-negative state.

“And I think as we go, over time, and we think about strategies for maintenance, we’re going to start using more MRD testing to determine who needs to continue on therapy versus not,” Fonseca said.

He added that MRD testing is also used to monitor patients on maintenance therapy who have a durable remission. The testing is done to inform conversations with patients about whether or not they should continue with maintenance therapy.

Fonseca and Noopur S. Raje, MD, of Massachusetts General Hospital Cancer Center and Harvard Medicine School, agreed that 10-6 is the target sensitivity, which can detect the presence of 1 cancer cell within 1 million cells…

As drug combinations evolve, MRD testing is more relevant than ever, said Raje.

“Given that we’re already talking about 3- and 4-drug combinations—and given that we have seen complete responses of anywhere between 40% and 50%—and if you’re then trying to compare these different quadruplets or triplets, I think using a tool such as MRD testing or looking for molecular remissions is the way forward,” she said.

Fonseca said that his clinic is doing MRD testing as part of the standard of care with patients who have undergone autologous stem cell transplantation being tested for MRD status on a visit that takes place 100 days over the transplant.

“Some recent clinical trial data show that MRD is really the goal, and it should be all that we aspire to,” Fonseca said. “…at the time you start therapy, I think the aspiration should be for patients to get to MRD-[negative] status.”

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