Dr. D'Agostino on Factors for Unsustained MRD Negativity in Multiple Myeloma

Mattia D'Agostino, MD, oncologist, Università degli Studi di Torino, discusses factors that could lead to unsustained minimal residual disease (MRD) negativity in patients with newly diagnosed multiple myeloma who are transplant eligible.

The phase 2 FORTE trial (NCT02203643) evaluated the safety and the efficacy of carfilzomib (Kyprolis) combined with cyclophosphamide and dexamethasone or lenalidomide (Revlimid) and dexamethasone followed by autologous stem cell transplant or 12 cycles of carfilzomib combined with dexamethasone and lenalidomide in patients with newly diagnosed multiple myeloma. Investigators examined factors that could predict unsustained MRD negativity in patients on the trial, and findings were presented at the 19th International Myeloma Society Annual Meeting.

Key factors associated with unsustained MRD negativity were novel risk factors, including high levels of circulating tumor cells at diagnosis, the amplification of 1q, and the presence of multiple cytogenetic abnormalities, D'Agostino says. Furthermore, the use of carfilzomib plus lenalidomide maintenance predicted a lower risk of MRD relapse, D'Agostino adds.

If a patient is MRD negative, disease relapse is less likely for many years, D'Agostino continues. However, patients at a high risk of MRD resurgence could relapse earlier if MRD negativity is not sustained, D'Agostino adds. If patients are aware that they are at higher risk for unsustained MRD negativity, they could be more open to maintenance therapy with a combination regimen, D'Agostino concludes.