Parameswaran Hari, MD, MRCP, discusses the role of minimal residual disease in multiple myeloma.
Parameswaran Hari, MD, MRCP, the Armand J. Quick/William F. Stapp Professor of Hematology, and the chief of the Division of Hematology/Oncology, Department of Medicine, at the Medical College of Wisconsin, discusses the role of minimal residual disease (MRD) in multiple myeloma.
In recent years, many advances have been made in the field of multiple myeloma, and now the majority of the agents that are used in induction treatment produce a 100% response rate, says Hari; this is great news for patient and providers and alike, he adds. Whether investigators are comparing 3, 4, or 5 drugs, the margin of benefit is limited in terms of increase in response rate, explains Hari. Notably, these advances have also resulted in a significant improvement in progression-free survival (PFS). Again, to show a difference in PFS, a large number of patients would need to be examined in a clinical trial with longer follow up, adds Hari.
Taking into consideration both of those aspects, MRD has become a surrogate endpoint that investigators can utilize, says Hari. It’s important to remember that when a surrogate endpoint is used, there is a possibility that it will not behave in the way that was initially intended, warns Hari. For example, an improvement can be observed with regard to MRD, but without a sustained benefit in terms of time. Ultimately, the goal of treatment for patients with multiple myeloma is time, says Hari, time off of relapse and time in remission.
It is important to keep in mind that MRD can serve as a surrogate in head-to-head comparison between 2 drugs or in a head-to-head comparison between 2 regimens, adds Hari. As such, MRD is here to stay and it is a key signal in myeloma, concludes Hari.