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Newly Diagnosed Multiple Myeloma- Best Plan
You are a newly diagnosed multiple myeloma patient wondering about the best therapy plan for you to undergo. Like most NDMM patients, you want the longest progression-free survival (PFS) with the least toxicity, aka chemotherapy.
As a long-term MM survivor who has experienced the good, the bad and the ugly of the world of MM, my view of “the best therapy plan” is to pursue the best of both conventional and evidence-based non-conventional MM therapies.
I believe prehabilitating followed by one of the induction therapies discussed below, will give you the greatest chance of achieving MRD negative status while undergoing a manageable amount of toxicity.
If you have the time before you begin induction therapy, please consider prehabilitation. If you are fortunate to achieve MRD negative status from induction therapy ONLY, consider skipping an ASCT and going straight to low-dose Revlimid therapy.
What does it mean when a myeloma patient is MRD negative?
Email me at David.PeopleBeatingCancer@gmail.com to learn more about managing your MM with the best of both conventional and non-conventional MM therapies.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
What percentage of newly diagnosed myeloma patients achieve MRD negative status following induction therapy only?
The percentage of newly diagnosed multiple myeloma (NDMM) patients who achieve minimal residual disease (MRD)-negative status following induction therapy only varies depending on the type of induction regimen used and the sensitivity of the MRD detection method. Here’s a general overview based on recent clinical studies and guidelines:
General Estimates (Post-Induction Only):
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Standard triple-agent regimens (e.g., VRd: bortezomib, lenalidomide, dexamethasone):
~15–30% of patients achieve MRD negativity post-induction. -
Quadruplet regimens (e.g., Dara-VRd: daratumumab + VRd):
~30–45% MRD negativity after induction.
Key Study Data:
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GRIFFIN Trial (Dara-VRd vs VRd)
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MRD negativity at 10⁻⁵ post-induction (before transplant):
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Dara-VRd: ~24%
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VRd: ~9%
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CASSIOPEIA Trial (Dara-VTd vs VTd)
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MRD negativity post-induction:
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Dara-VTd: ~28%
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VTd: ~13%
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GMMG-CONCEPT Trial (Isa-KRd in high-risk patients)
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MRD negativity post-induction: ~50% (10⁻⁵ sensitivity)
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Factors Affecting MRD Negativity Rates Post-Induction:
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Regimen intensity and composition
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Disease biology (standard vs high-risk cytogenetics)
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MRD detection sensitivity (e.g., 10⁻⁵ vs 10⁻⁶)
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Duration of induction therapy (number of cycles)
✅ Summary:
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15–45% of NDMM patients achieve MRD negativity after induction therapy alone.
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Rates are higher with quadruplet regimens that include monoclonal antibodies like daratumumab or isatuximab.
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Achieving MRD negativity at this stage is a strong predictor of improved progression-free survival.
What is the average progression-free survival for myeloma patients who maintain MRD-negative status following induction therapy and 3 years of maintenance therapy?
The average progression-free survival (PFS) for multiple myeloma (MM) patients who achieve and maintain minimal residual disease (MRD)-negative status after induction therapy and 3 years of maintenance therapy is notably prolonged compared to MRD-positive patients.
Key Insights from Clinical Studies:
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MRD-negativity is the strongest predictor of PFS in MM. Patients who are MRD-negative after induction and during maintenance can experience significantly extended remission.
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Based on recent data from clinical trials such as:
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FORTE Trial (Palumbo et al.)
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MASTER Trial (NCT03224507)
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GEM2012MENOS65 Trial
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IFM 2009 Study
Patients who are sustained MRD-negative after induction and during maintenance (e.g., lenalidomide) can have median PFS exceeding 5 to 6 years, and sometimes even longer.
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MRD negativity sustained for at least 1 year is associated with a >80% 5-year PFS rate in several trials.
Summary Estimate:
For MM patients who:
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Achieve MRD-negativity post-induction,
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Remain MRD-negative during and after 3 years of maintenance,
📌 Average progression-free survival: 5 to 7 years, and potentially longer, especially if MRD-negativity is sustained and deep (e.g., 10⁻⁵ or 10⁻⁶ sensitivity by NGS or flow cytometry).
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