Using MRD, Patient Preference to Optimize Multiple Myeloma Care

Minimal residual disease (MRD) testing is becoming a pivotal tool in personalizing multiple myeloma treatment, explains Hans Lee, MD, director of multiple myeloma clinical research, associate professor in the Department of Lymphoma/Myeloma at the University of Texas MD Anderson Cancer Center.

During this conversation, Lee delves into the growing role of MRD testing and how results guide transplant timing and maintenance therapy deintensification. He also highlights the balance between patient preferences and long-term outcomes with advanced therapies like CAR T-cell and bispecific antibodies.

This transcript has been lightly edited for clarity.

Transcript

What role do biomarkers like MRD play in refining treatment decisions for transplant-eligible vs ineligible patients?

We have been using MRD testing more and more in the recent years to help guide therapy as more and more data comes out regarding this. For newly diagnosed patients, I may use MRD testing to decide whether or not to pursue upfront transplant or a delayed transplant approach in standard-risk multiple myeloma patients. So, if a patient has standard risk multiple myeloma [and] has attained MRD negativity to frontline induction therapy, I may consider deferring transplant after a conversation about the risks and benefits with the patient.

I think on the back end, where MRD can also be very helpful is knowing when to deintensify therapy. I think we're getting more and more data about perhaps there are some patients who have been on long-term lenalidomide maintenance therapy after transplant who have sustained MRD negativity where we could potentially stop therapy. And there's now data coming out of a couple of groups, such as the University of Chicago and Memorial Sloan Kettering, that have shown that this approach is feasible, even after stopping lenalidomide maintenance in patients with sustained embryonic negativity, that these patients can remain in remission for a very long time. So, that's something else that I've also started to incorporate in my practice as well. And there are more and more prospective studies that are looking at this sort of deintensification of maintenance therapy based on MRD testing that will be reported in the future.

How do you balance patient treatment selection with the need to optimize long-term outcomes and cost-effectiveness?

It's really great that we have both options, CAR T therapies and bispecific antibodies, available for our patients in 2024. Both are highly efficacious; they both have pros and cons. I think that it's nice that we can tailor the therapies according to patient preference and what they could potentially receive depending on other circumstances—social circumstance, if they have a caregiver or not, whether they have a more active lifestyle where perhaps a more one-and-done approach might be more appealing to them with CAR T therapy. So [it's] really a great thing that we have lots of options for our patients to consider in this context.