Publication details

Real-World Evidence on Prognostic Value of MRD in Multiple Myeloma Using Flow Cytometry

Authors	MURONOVA Ludmila SOUCEK Ondrej ZIHALA David SEVCIKOVA Tereza POPKOVA Tereza PLONKOVA Hana VENGLAR Ondrej POUR Luděk ŠTORK Martin RIHOVA Lucie BEZDEKOVA Renata MINARIK Jiri LATAL Vojtech NOVAK Martin JUNGOVA Alexandra DEKOJOVA Tereza STRAUB Jan SPACEK Martin REZACOVA Vladimira MAISNAR Vladimir RADOCHA Jakub HAJEK Roman JELINEK Tomas
Year of publication	2024
Type	Article in Periodical
Magazine / Source	European Journal of Haematology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://onlinelibrary.wiley.com/doi/10.1111/ejh.14316
Doi	http://dx.doi.org/10.1111/ejh.14316
Keywords	lenalidomide maintenance; minimal residual disease (MRD); multiparameter flow cytometry; multiple myeloma; overall survival (OS); progression-free survival (PFS); real-world
Description	Minimal residual disease (MRD) is one of the most important prognostic factors in multiple myeloma (MM) and a valid surrogate for progression-free survival (PFS) and overall survival (OS). Recently, MRD negativity was approved as an early clinical endpoint for accelerated drug approval in MM. Nevertheless, there is limited evidence of MRD utility in real-world setting. In this retrospective multicenter study, we report outcomes of 331 newly diagnosed MM patients with MRD evaluation at Day+100 after autologous stem cell transplantation using flow cytometry with a median limit of detection of 0.001%. MRD negativity was reached in 47% of patients and was associated with significantly prolonged median PFS (49.2 months vs. 18.4 months; hazard ratios (HR) = 0.37; p < 0.001) and OS (not reached vs. 74.9 months; HR = 0.50; p = 0.007). Achieving MRD negativity was associated with PFS improvements regardless of age, International Staging System (ISS) stage, lactate dedydrogenase (LDH) level, or cytogenetic risk. Importantly, MRD positive patients benefited from lenalidomide maintenance versus no maintenance (18-months PFS: 81% vs. 46%; HR = 0.24; p = 0.002) while in MRD negative patients such benefit was not observed (p = 0.747). The outcomes of our real-world study recapitulate results from clinical trials including meta-analyses and support the idea that MRD positive patients profit more from lenalidomide maintenance than MRD negative ones.