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Landgren Explains Crucial Role of MRD in Myeloma

Brandon Scalea
Published: Thursday, Dec 13, 2018

C. Ola Landgren, MD, PhD
C. Ola Landgren, MD, PhD
It is becoming clear that minimal residual disease (MRD) negativity is a crucial prognostic factor in patients with multiple myeloma, said C. Ola Landgren, MD, PhD.

Landgren discussed the role of MRD negativity and the emergence of CAR T-cell therapy in multiple myeloma.

OncLive: What is the role of MRD in multiple myeloma?

Landgren: MRD is currently moving into many disease areas. In multiple myeloma, this has been going on for more than 10 years. Now, we are at a point that MRD plays a crucial role in clinical trials; it is an important clinical outcome. We have data from multiple studies and 2 meta-analyses showing that MRD negativity is indicative of longer PFS. We know that MRD negativity is a highly clinically meaningful prognostic marker in clinical trials. MRD negativity has been tested against cytogenetics and other important clinical markers and data show that MRD negativity is a stronger prognostic factor.

Additionally, there are now clinical trials showing that patients who achieve MRD negativity both in the newly diagnosed and relapsed/refractory settings have similar clinical outcomes; this is independent of the treatment arm they were on in the respective clinical trials. Simply, a 3-drug regimen versus a 2-drug regimen was being tested in a randomized matter. In both arms, there were patients achieving MRD negativity at some point. We looked at the patients' PFS outcomes. Data show that the patients who receive the more aggressive regimen have outcomes [similar to those who receive] the less aggressive regimen, as long as they achieve MRD negativity. 

Is there a specific assay for MRD testing that should be used across practices?

For a long time, researchers have been looking at different platforms for doing this. Some groups were in a laboratory trying to decide if we should use polymerase chain reaction primers based on the sequencing and the development of patient-specific primers. Over the years, the molecular field has evolved and moved forward very fast.


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