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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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Myeloma MRD Post Induction?
Can newly diagnosed myeloma reach MRD post induction therapy without also having an autologous stem sell transplant and achieve longer progression-free survival (PFS) and overall survival (OS)?
According to the study below, yes. So why is this so important?
Every study, every clinical trail that I have read begins the same way. By stating that the study patients undergo the FDA approved standard-of-care therapy plan for newly diagnosed myeloma patients of:
- Induction chemotherapy (triplet or quadruplet)
- Autologous stem cell transplant
- Low-dose maintenance therapy (usually revlimid aka lenalidomide)
This basic therapy plan is what the FDA says all NDMM patients should do at the beginning of their therapy. Fine.
But what about NDMM patients who reach MRD status (negative or positive) after only undergoing their induction therapy?
If Minimal Residual Disease (negative or positive) means the presence of only four or five MM cells per million normal cells- it means that the NDMM patient has achieved an exceptionally good response to their induction therapy.
Why would the NDMM need to undergo more aggressive, high-dose toxicity in the form of an autologous stem cell transplant, if that NDMM patient has already responded to treatment as deeply as any NDMM patient ever has responded to treatment?
Let’s not forget that multiple myeloma is an incurable blood cancer. No conventional therapy has ever cured a MM patient. MRD is the best any patient can hope for.
What does it mean for the newly diagnosed myeloma patient to achieve minimal residual disease post induction therapy?
For newly diagnosed myeloma patients, achieving MRD negativity post-induction therapy is associated with several potential benefits:
- Improved Prognosis: MRD negativity indicates a deeper response to treatment, which is often associated with better long-term outcomes, including prolonged progression-free survival and overall survival.
- Reduced Risk of Relapse: Patients who achieve MRD negativity are less likely to experience a relapse or recurrence of the disease compared to those with detectable residual disease.
- Potential for Treatment Modification: MRD negativity may influence treatment decisions, potentially allowing for treatment modifications such as reduced intensity maintenance therapy or longer intervals between treatments while maintaining efficacy.
- Quality of Life: Knowing that the disease burden has been significantly reduced or eliminated can provide psychological relief and improve the patient’s overall quality of life.
- Research and Clinical Trials: Patients who achieve MRD negativity may be eligible for participation in clinical trials evaluating novel therapies or treatment strategies, contributing to advancements in myeloma treatment.
Only a few days ago I was writing about a study documenting how a year of consistent MRD coupled with low-dose revlimid was associated with a longer PFS and longer OS. But, as always, inclusion in that study required the FDA approved therapy plan of induction therapy, ASCT and low-dose maintenance therapy.
If a patient wants to pursue a control approach to treatment as outlined by MM specialist Dr. Vincent Rajkumar in his essay Treatment of Myeloma: Cure vs. Control, and they reach MRD status before undergoing an autologous stem cell transplant, they, the patient, may one want to undergo more toxicity at that time.
Yes, newly diagnosed myeloma patients can reach MRD post induction therapy without also having an autologous stem sell transplant and then hope to achieve longer progression-free survival (PFS) and overall survival (OS).
Are you a NDMM patient? If you would like to learn more about both conventional and evidence-based non-conventional MM therapies email me at David.PeopleBeatingCancer@gmail.com
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Minimal Residual Disease (MRD) Testing in Newly Diagnosed Multiple myeloma (MM) Patients: A Prospective Head-to-Head Assessment of Cell-Based, Molecular, and Molecular-Imaging Modalities
“Introduction: Recent studies show better progression-free (PFS) and overall survival (OS) for newly diagnosed multiple myeloma (NDMM) pts achieving MRD negativity by
- multicolor flow cytometry (MFC) or
- next-generation sequencing (NGS).
Here, we report on the comprehensive assessment of MRD in a uniformly treated cohort of 45 MM patients…
45 NDMM pts were treated with 8 cycles of combination therapy (carfilzomib, lenalidomide and dexamethasone) followed by 2 years of maintenance lenalidomide. Median potential follow-up was 17.3 mos. All patients were evaluated by NGS by LymphoSIGHT™ method…
Conclusions: This prospective evaluation of MRD testing in MM has several key findings:
1. Detection of myeloma-specific clonotypes by NGS of the Immunoglobulin VDJ segments in the BM is feasible in majority of pts with NDMM.
2. MRD detection by NGS compares favorably to MFC since all pts with residual disease by MFC are also MRD positive by sequencing; an additional 8 pts who were MRD negative by flow MFC were MRD positive by sequencing.
3. MRD negativity by MFC and NGS are both associated with significantly better PFS.
4. Detection of myeloma-specific clonotypes by NGS of the immunoglobulin VDJ segments (i.e. cell free DNA) in the peripheral blood plasma is feasible in NDMM pts at diagnosis; however, since tumor load in the plasma is >2000-fold lower than in the BM; using standard volumes of peripheral blood (plasma), the levels of myeloma-specific clonotypes were too low to be quantified already after 2 cycles of combination therapy.
This was true despite presence of positive serum electrophoresis and/or immunofixation. Additional studies to understand the dynamics of the myeloma clonotype level in peripheral blood plasma are necessary to determine optimal MRD testing regimen…”