Minimal residual disease (MRD) in multiple myeloma: Prognostic and therapeutic implications (including imaging)
EHA Library. Owen R. Jun 15, 2019; 273695
Roger Owen
Roger Owen
Learning Objectives

Sonja Zweegman - Chair introduction

Multiple myeloma (MM) is an incurable plasma cell malignancy evolving from monoclonal gammopathy of undetermined significance (MGUS) and smolderingMM(SMM). The rate of transformation from MGUS toMMis constant over time; 1% per year. In contrast, the change of developing MM in SMMis decreasing over time from 10% per year in the first 5 years of diagnosis to 1% per year 10 years thereafter. This indicates a pronounced inter-patient heterogeneity. In clinical practice, mainly the tumor burden, defined as percentage of plasma cells, M-protein level and repression of normal immunoglobulins is used to predict the progression to MM. The biological background for the heterogeneity in developing tumor burden however is less well defined, indicating a role for genetic abnormalities, but not fully explaining it. Dr Irene Ghobrial will discuss the role of the microenvironment in inducing progression of plasma cell dyscrasia, with a special emphasis on the immune-microenvironment.
Comparable inter-patient heterogeneity applies to the prognosis and treatment outcome in MM. Comparable to precursor states the microenvironment plays a role alongside biological features of the disease of which genetic abnormalities are best characterized, being commented on by Dr Irene Ghobrial and Dr Michele Cavo. However, regardless of the biological risk, reachingminimal residual disease (MRD) negativity has been found to be a strong predictor of survival,which appeared to be also independent fromdisease state and type of treatment that led toMRDnegativity. Themethodology to detect residual cellswith high sensitivity (both in bone marrowand bone), the impact of MRD status on outcome and how to implement this assay in clinical practice will be discussed by Dr Roger Owen. Furthermore, Dr Owen will show the clinical trials with MRD as an outcome parameter.
Finally, Dr Michele Cavo will give an overview on the current state of the art of front line treatment of MM. Moreover, it will be discussed how to implement biological parameters of the disease in the choice of treatment.

Learning goals of the article
• To gain insights in how the (immune-)microenvironment drives evolving of the disease from MGUS to MM and how this knowledge might give rise to future therapeutic targeting.
• To know the methods to detect MRD and the prognostic impact of MRD.
• To know the most commonly used treatment regimens in front line therapy of multiple myeloma and to understand the different factors that guide treatment decisions.

Learning goals of the presentation
Not available

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