Dr Elisabet Manasanch Highlights MRD Assessment Accuracy in Predicting Treatment Progression

April 7, 2020

MRD assessments are probably 1 of the most powerful predictors that we have to see how well a treatment has worked, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

MRD assessments are probably 1 of the most powerful predictors that we have to see how well a treatment has worked, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Transcript

How accurate is MRD assessment at judging how deep remission is or how well a treatment worked?

So, it's actually very accurate. It's probably 1 of the most powerful predictors that we have to see how well a treatment has worked. In fact, most patients that do not achieve a complete remission will be minimal residual disease positive so that just tells you how good that is. There could be some instances, which are not many, where a patient could have what we call extramedullary disease—it’s a patient with multiple myeloma [who] comes in and has some mass or something somewhere, for example, in the ribs. It's not uncommon to have lesions in the bones that maybe have a little bit of a mass and then you treat the patient, and you do your MRD assessment in the bone marrow, which is basically just taking a little bit of blood from the bone marrow, maybe like a couple of millimeters or something like that.

Then you test that and that's negative, but then you do a PET CT or you do an MRI and you still see that there is something left in terms of where that rib lesion had been. So, in that situation, the patient obviously is not yet in remission—I mean, there's myeloma left, and you can treat that and keep checking the MRD, but sometimes there are some situations where MRD may tell you that it's negative, but there may be some residual disease; but these are not most of the situations in myeloma. So this is why again, for the response criteria, there's an imaging and MRD negativity. So, you can also do some imaging like whole body imaging, whole body PET CT is useful in these circumstances, as would be MRI.