Multiple Myeloma Minimal Residual Disease
Assessment of minimal residual disease (MRD) is becoming standard diagnostic care for potentially curable neoplasms such as some acute leukemias as well as chronic myeloid and lymphocytic leukemia. Although multiple myeloma (MM) remains as an incurable di
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bstract
Assessment of minimal residual disease (MRD) is becoming standard diagnostic care for potentially curable neoplasms such as some acute leukemias as well as chronic myeloid and lymphocytic leukemia. Although multiple myeloma (MM) remains as an incurable disease, around half of the patients achieve complete remission (CR), and recent data suggests increasing rates of curability with “total-therapy-like” programs. This landscape is likely to be improved with the advent of new antibodies and small molecules. Therefore, conventional serological and morphological techniques have become suboptimal for sensitive evaluation of highly effective treatment strategies. Although, existing data suggests that MRD could be used as a biomarker to evaluate treatment efficacy, help on therapeutic decisions, and act as surrogate for overall survival, the role of MRD in MM is still a matter of extensive debate. Here, we review the different levels of remission used to define depth of response in MM and their clinical significance, as well as the prognostic value and unique characteristics of MRD detection using immunophenotypic, molecular, and imaging techniques.
B. Paiva J.F. San Miguel (&) Centro de Investigacion Medica Aplicada (CIMA), Clinica Universidad de Navarra, IDISNA, Pamplona, Spain e-mail: [email protected] R. García-Sanz Hospital Universitario de Salamanca, Centro de Investigación Del Cancer (IBMCC-USAL, CSIC), Instituto de Investigaion Biomedica de Salamanca (IBSAL), Salamanca, Spain © Springer International Publishing Switzerland 2016 A.M. Roccaro and I.M. Ghobrial (eds.), Plasma Cell Dyscrasias, Cancer Treatment and Research 169, DOI 10.1007/978-3-319-40320-5_7
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Key facts The higher efficacy of new treatment strategies for MM demand the incorporation of highly sensitive techniques to monitor treatment efficacy MRD could be used as a more potent surrogate biomarker for survival than standard CR We need to understand the pros and cons of the different MRD techniques The time has come to incorporate highly sensitive, cost-effective, readily available, and standardized MRD techniques into clinical trials to assess its role in therapeutic decisions
Keywords
Myeloma
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MRD Surrogate Flow NGS PET/CT
The Definition of Complete Response in MM: An Historical Overview
Changes in the level of the serum paraprotein and/or urinary light-chain excretion form the basis of assessing the response to therapy and monitoring the progress of MM. Response criteria were first developed by the Committee of the Chronic Leukemia and Myeloma Task Force (CLMTF) of the U.S. National Cancer Institute in 1968 and were reviewed by the same group in 1973. The main response parameter was a reduction in the paraprotein of at least 50 %. In 1972 the Southwest Cancer Chemotherapy Study Group, now the Southwest Oncology Group (SWOG), defined ‘objective response’ as a reduction of at least 75 % in the calculated serum paraprotein synthetic rate (rather than paraprotein concentration) and/or a decrease of at least 9
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