Dr Thomas Martin Outlines How MRD Testing Is Being Used

This interview was originally conducted by OncLive. View more interviews with Thomas G. Martin, MD.

Currently, minimal residual disease testing is being used for prognostication not for treatment decisions, explained Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, associate director, Myeloma Program, University of California, San Francisco (UCSF); co-leader, Hematopoietic Malignancies Program, Helen Diller Family Comprehensive Cancer Center.

Transcript

How is minimal residual disease (MRD) testing being used in patients with multiple myeloma?

I think we are a little bit in myeloma, I say, putting the cart before the horse, in terms of MRD testing in myeloma. Yes, we’re doing it very frequently at the university and we’ve been doing it for the last 2 to 5 years at UCSF. We have a very good relationship with doing PCR-based next-generation sequencing MRD testing.

However, now, this is to be done, in my mind, in the context of a clinical trial or at a university. So really for us, it’s only about prognosis. We are making no treatment decisions based on MRD status at the current time. What we know from front-line studies and also from early relapse studies that those patients that achieve an MRD-negative state, and that’s either by PCR next-generation sequencing data or by EuroFlow, the multicolor flow cytometry, that those patients that achieve a deep remission, are MRD negative, certainly have a longer progression-free survival. So, it’s a prognostic marker.

We don’t know what to do with that data in terms of treatment. Should we not give maintenance? Should we shorten maintenance? Should we switch our maintenance? Those are questions that will be tested, literally, in the next 2 to 5 years in clinical trials. And many clinical trials are now using that as an end point for treatment decision, which is great. Right now, again, prognostic marker that we use in the university or in the context of the clinical trial. But really trying not to change any medications based on MRD.