Multiple myeloma is one of the most common haematological malignancies which happens worldwide. Almost half a million people are affected by multiple myeloma every year. This disease is incurable and is usually chronic but with the current treatment modalities which are available we can extend the lifespan of these patients and make them live longer.

Our approach in my study is to find out the MRD testing. MRD is called minimal residual disease testing which is done in the course of multiple myeloma treatment in patients to check whether they have how much of monoclonal cells left in their body, to make sure are they disease free or do they need treatment or do we have to change the regimen. This MRD testing has been highly encouraged by the International Working Committee of Multiple Myeloma, saying that these MRD negative patients have a better prognosis in terms of overall survival, meaning they leave longer as compared to the patients who have MRD positivity as well as progression free survival of the disease. So they live longer without the disease progressing.

My and my colleagues’ main aim in this study is to bring to the world is there any difference between the MRD testing done across the world. So what are the perspectives of the oncologists who are dealing with multiple myeloma and how do they think or are they doing MRD testing or what is their take on the MRD testing.

What was the study design?

This is a cross-sectional survey-based study. We actually sent the survey to almost 160 oncologists as well as haematologists across the world and almost 115 people responded back to us. This consisted of almost 15 questions in the survey where each question pertains to an answer or that is the entire result section made up of.

What are the key results?

The results were quite interesting. We wanted to check out the reasons, how much people in the US, oncologists in the US, order MRD testing, that is North America, versus the rest of the world. But we were able to find surprisingly different perspectives of people, or oncologists, ordering this MRD testing.

Almost 42% of the people from the US, 42 oncologists from the US answered the survey. Out of these 22 oncologists were already MRD testing, they were in favour of MRD testing, which is more than 50%. Whereas in the rest of the world, as taken away from the US, almost 79 oncologists answered the survey. Out of them only 28 people did MRD testing which is less than 50%. So MRD testing is commonly and majorly practised in the US but when you compare the rest of the world the oncologists are not doing enough MRD testing.

We wanted to dig more into the reasons of the physicians, what makes the physician not order an MRD testing. The common reasons from non-US, away from the US or not from North America, the rest of the world, the major reason given by them was the unavailability of the test. The test is unavailable to them due to multiple reasons. The other thing is the expensiveness of the test. This MRD testing is quite expensive so people were not encouraged to do this test.

The other reason being unclear benefit but they were negligent, [??]% of people said there is unclear benefit so we don’t want to do it. But the majority of the reason given by them was the unavailability of the test. If something is unavailable in some part of the world they are not able to do it.

We wanted to bring these results into the attention of people to have nationalised guidelines for this MRD testing. To date there is no national or standardised guidelines this is when you should do an MRD testing or how often you should do an MRD testing. All these results or all these are given as suggestions but there is no guidelines. We wanted to make sure we have the attention of we don’t have guidelines and we want more guidelines.

One thing, on the other hand, when you take a US population the reason for not ordering the MRD testing was a lack of guidelines. So no-one knows when to order MRD testing. It’s more like a clinical approach as well as different oncologists, how they perceive it.

What is the significance of these results?

Next for the study is the major reason, necessitating the need for standardised guidelines, that is one of the things which I see in the future. So this study would give attention to people so that they think that they need more standardised guidelines so that everyone gets uniform treatment. And maybe finding out new ways to help the people from underprivileged countries to have more of these testing centres in their country so this cancer care is accessible to them as well.