Dr Lonial talks to ecancertv at IMW 2013. Complete response is now a feasible endpoint in multiple myeloma (MM) with the advent of novel therapies. As a result more sensitive methods are now required to measure minimal residual disease (MRD).
These include polymerase chain reaction (PCR) and multiparameter flow cytometry (MFC). PCR identifies heavy chain gene rearrangement in bone marrow aspirate and is probably more sensitive that MFC.
However, MFC is a relatively easier test to do, it is transportable and it is not patient specific. The measurement of MRD can be used to predict patient outcomes and prognosis and can help guide therapeutic decisions.
The MRC Myeloma IX study demonstrated that thalidomide-based maintenance after autologous stem cell transplant (ASCT) could help to decrease or even eradicate MRD after an initial response and so improve survival. In this study, differences were seen in outcomes across different patient subgroups, with less MRD negatively seen in high risk patients, as measured by fluorescence in situ hybridisation (iFISH). It was believed that the overall effect of thalidomide was maintenance and not consolidation.
Imaging with PET/CT and MRI, in addition to MFC, can also provide useful information in the assessment of MRD.
Interesting data has also been presented by the Spanish group on high risk smouldering MM patients.
This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).