Published on October 18, 2018
What is the role of minimal residual disease (MRD) testing in multiple myeloma care? Can it measure how effective therapies are? Renowned myeloma expert Dr. Rafael Fonseca, from the Mayo Clinic in Arizona, explains what MRD testing can detect about a patient’s response to therapy, remaining myeloma cells and what it means for the course of treatment. How is MRD measured? Dr. Fonseca also discusses how MRD status is determined and when it’s appropriate to use this type of testing. Watch now to find out more.
This town meeting is sponsored by Amgen, Janssen Pharmaceuticals and Adaptive Biotechnologies. It is produced by Patient Power in partnership with Winship Cancer Institute of Emory University.
Transcript | What Is the Role of Minimal Residual Disease (MRD) Testing in Myeloma Care?
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So MRD stands for minimal residual disease. That's what it means, and there's various ways to measure this, and it's probably not worth going into a technicality, but just know that we can ask questions such as, is there a myeloma cell in these 100,000 cells that I have in front of me, or is there a myeloma cell amongst these million cells that I have in front of me. And that is the question we're asking with minimal residual disease or MRD testing.
We do it as a matter of routine. So when a patient completes a bone marrow transplant, a stem cell transplant, we do it at day 100. Now, for those of you who have dealt with this you realize if the test is negative it does not tell you that there is evidence of no disease. What it tells you is there is no evidence of disease, which are fundamentally different things, right? So we cannot tell someone that even though they are MRD negative that I can tell you 100 percent that there is no cells remaining in your body. But what I can tell you is that the level of sensitivity of one in a million, we couldn't find a cell. So you're going to see this being used more and more.
This is particularly useful for those situations where the myeloma responds very deeply. If you're going through myeloma treatment, say, it's getting things under control but there still is an M spike, it doesn't make a lot of sense to use MRD testing. But if you are in that complete remission we use that. And more recently we're using this to determine for how long someone should stay on therapy.
So I have patients who have been on lenalidomide (Revlimid) for greater than 10 years or patients who have maintenance post-transplant for four years, and they may start to have side effects. So they might ask me, can I stop treatment or not? So without knowing all the answers for certain, this is one of the various pieces of information we're bringing together, so we might do a bone marrow on that person and say, you know, if the MRD is negative and you have those side effects, maybe it's reasonable that we consider stopping therapy. And that's how we're used that MRD testing.
And MRD negative, as you know, negative in medicine is a good thing usually. MRD negative means there's no detectable cells by this technique.
So there's no cut-and-dried—if I'm MRD negative after maintenance of two years there's no cut-and-dried statement that you can stop therapy, but it might be an individual case where you look at trying to determine that.
I think it has to be individualized, and the trials are being done, but we do a lot of things like that in medicine. So if someone is on the fence and tells me, listen, I don't know if I should stop or not, then I go, maybe we can do a bone marrow. And there's a lot of aspects to that decision, right? A person might say, well, even if I'm negative I'm fearful of stopping my treatment because it's been going so well. Fine, we're keep going on treatment. But if you're on the fence and the MRD is negative, then that may be the last bit of information that would make you say, well, I'm going to stop and just go under observation only.