According to the article linked below, myeloma long-term overall survival is associated with achieving minimal residual disease status for one year after the newly diagnosed myeloma (NDMM) patient completes their induction therapy, ASCT and low-dose maintenance therapy.
If I understand this correctly, NDMM patients who reach MRD- status after treatment and remain in MRD- status for an entire year- these patients have a good chance of achieving a longer PFS (progression-free survival aka first remission) and longer OS (overall survival aka length of life).
I have found that trying to figure out what studies don’t say is more interesting than what they do say. Let me give you some examples.
- The study talks about autologous stem cell transplantation. Some NDMM patients reach MRD- status after 4 or 5 founds of induction therapy. Do they need to also have an ASCT too? Or can they harvest and store their stem cells?
- Like most studies, the one below does not mention anything about the NDMM patients. Are they representative of ALL NDMM or are they younger, healthier, etc. that average?
- Likewise, the studies does not mention anything about high risk- either genetic high risk or CRAB high-risk.
- Lastly, what is the dose of “low-dose maintenance lenalidomide?” 5 mg? 10 mg? Just curious.
- Probably the most important question- after these MRD- patients reach the one year marker, do they stop all treatment? Must they continue? Revlimid has an increased risk of treatment-related secondary cancer. I sure would like to know if I could stop therapy once I reach the magic one year mark.
This maybe just me but I’ve always wanted to compare a low-dose approach to managing MM to the “standard-of-care” therapy plan outlined in the study (induction, ASCT, low-dose maintenance).
Especially if the NDMM patient is stage 1 with few if any CRAB symptoms. I mean, why undergo all that toxicity if you don’t need to???
Are you a newly diagnosed MM patient? Perhaps you are a NDMM patient who has reached MRD- status after undergoing only induction therapy?
man hand holding his nutritional supplemets, healthy lifestyle background.
If you would like to learn more about both conventional and non-conventional MM therapies email me at David.PeopleBeatingCancer@gmail.com
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“Purpose-Prognostic Immunophenotyping in Myeloma Response (PRIMeR) is an ancillary study of minimal residual disease (MRD) assessment for multiple myeloma by next-generation multiparameter flow cytometry (MFC). Patients were enrolled on a three-arm randomized control trial (Blood and Marrow Transplants Clinical Trials Network 0702 Stem Cell Transplant for Myeloma in Combination of Novel Agents [STaMINA]; ClinicalTrials.gov identifier: NCT01109004).
Methods- Four hundred and thirty-five patients consented to the MRD panel, which included 10 monoclonal antibodies measured via six-color MFC. MRD was measured at baseline/preautologous hematopoietic cell transplant (BL/preAutoHCT), premaintenance (PM), and 1 year (Y1) after AutoHCT with a sensitivity of 10–5 to 10–6. The primary objective was to assess MRD-negative (MRDneg) at 1 year after AutoHCT and progression-free survival and overall survival (PFS/OS).
Results- Similar to the STaMINA results, at a median follow-up of 70 months, there was no significant difference in PFS/OS by treatment arm in the PRIMeR patients. MRDneg at all three time points was associated with significantly improved PFS, and MRDneg at Y1 had significantly longer OS. Multivariate analysis of PFS, adjusting for disease risk and treatment arm, demonstrated hazard ratios (HRs) in MRD-positive patients compared with MRDneg patients at BL, PM, and Y1 of 1.55 (P = .0074), 1.83 (P = .0007), and 3.61 (P < .0001), respectively. Corresponding HRs for OS were 1.19 (P = .48), 0.88 (P = .68), and 3.36 (P < .001). Patients with sustained MRDneg or who converted to MRDneg by Y1 had similar PFS/OS…
Conclusion- To our knowledge, this first, prospective US cooperative group, multicenter study demonstrates that MRDneg at Y1 after AutoHCT with lenalidomide maintenance is prognostic for improved 6-year PFS and OS.”
