Dr C. Ola Landgren: MRD Is a Growing Topic of Interest in Cancer

While minimal residual disease (MRD) has been a topic of research for at least a decade, right now it is more top of mind than ever before for people treating cancer, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

How is our understanding of MRD and what it means for treatment decisions evolving?
Minimal residual disease is a topic that is on everybody's lips these days. You cannot attend one single meeting without hearing about the minimal residual disease [MRD] testing in myeloma and other diseases, as well. I have worked on it for more than 10 years, and we worked on it in the laboratory. We have used flow cytometry-based, we have used PCR [polymerase chain reaction]-based, we have done next generation sequencing based, we have done proteomic-based [testing], and we also have started doing immuno-PET–based imaging for minimal residual disease.

All the data in multiple myeloma that has been generated from larger studies show that if you treat a newly diagnosed patient and he or she obtains him MRD negativity, that's probably the strongest prognostic factor for a long progression-free survival. And there is that even showing that it could be a prognostic factor associated with long overall survival. We published the first meta-analysis back in 2016, and there was a subsequent meta-analysis in 2017, using very similar data sets, plus some additional older data sets, as well. So, there are 2 meta-analyses in showing in myeloma that MRD is very important, prognostically.

There is not yet any study that has been published that's designed to use MRD for decision making, but there are several ongoing studies, we have at our center, as well, looking at the role of MRD as a decision tool to determine whether therapy could be increased in intensity or decreased or could you even use patients that are MRD negative for many years and use that MRD to determine whether patient potentially could even be stopped for therapy. So, those are studies that are ongoing, and it will be very interesting to see what the data shows.
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