I have a general question about minimal residual disease (MRD) testing. Is it common for multiple myeloma patients to have MRD testing done regularly?
I have regular blood tests to check for M-spike and my free light chain (kappa and lambda) levels and ratio. I also have had a yearly bone marrow biopsy for the last 3 years. As far as those tests go, I still have a complete remission. But I have no idea if I am minimal residual disease negative or positive.
My understanding is that unless you are in some sort of study, very few people are actually tested for minimal residual disease. Is that correct?
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DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
Re: How common is minimal residual disease (MRD) testing?
Kent,
I speak only from personal experience. Others please correct me if I'm wrong.
If your complete response was determined based upon your blood and bone marrow biopsies and no (zero) monoclonal cells were detected, it might just be the formality of declaring MRD negative.
I would imagine if you are having a bone marrow biopsy they are going to thoroughly analyze it to that level.
I speak only from personal experience. Others please correct me if I'm wrong.
If your complete response was determined based upon your blood and bone marrow biopsies and no (zero) monoclonal cells were detected, it might just be the formality of declaring MRD negative.
I would imagine if you are having a bone marrow biopsy they are going to thoroughly analyze it to that level.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: How common is minimal residual disease (MRD) testing?
Hi Kent,
Craig gave you some good information, and I'd like to add a bit more.
To test for MRD in multiple myeloma, two techniques are used now - flow cytometry and polymerase chain reaction (PCR). Flow cytometry is cheaper and is sensitive to about 1 in 100,000 cells, whereas PCR is sensitive to about 1 in 1,000,000 cells. It's my understanding that a given center looking at MRD will use one or the other of these tests. I'm treated at Memorial Sloan Kettering (MSK), and they use flow cytometry there.
These tests are not "standard," in the sense that they are not done routinely whenever a bone marrow biopsy (BMB) is performed. It doesn't make sense to do them if a patient is not in CR or near-CR since less sensitive measures can pick up the presence of myeloma cells in the bone marrow when there are "lots" of them.
As you mentioned, it has been the case that MRD testing has been done in some clinical trials for a few years now. (For multiple myeloma patients. MRD testing has been used longer in treating leukemia patients.) However, some myeloma centers are moving toward making MRD testing routine for patients who may be MRD negative. The head of the multiple myeloma department at MSK (Dr. Ola Landgren) mentioned to me a couple years ago that he is hoping to do just that at MSK. I don't know if that has happened yet.
I am in a clinical trial where I get tested for MRD once a year. My BMB for that test will be coming up around the end of August, so I'm keeping my fingers crossed that I'll still be MRD negative then!
I'd suggest asking your doctor whether you've been tested for MRD, and, if so, what the results were.
One other thing - although it's a slightly different question, there is another current thread about MRD that you might want to look at:
"Understanding my minimal residual disease" (started July 16, 2016)
Ron Harvot and JPC have both provided informative replies there.
Here's hoping you are MRD negative and stay that way for a long time!
Mike
Craig gave you some good information, and I'd like to add a bit more.
To test for MRD in multiple myeloma, two techniques are used now - flow cytometry and polymerase chain reaction (PCR). Flow cytometry is cheaper and is sensitive to about 1 in 100,000 cells, whereas PCR is sensitive to about 1 in 1,000,000 cells. It's my understanding that a given center looking at MRD will use one or the other of these tests. I'm treated at Memorial Sloan Kettering (MSK), and they use flow cytometry there.
These tests are not "standard," in the sense that they are not done routinely whenever a bone marrow biopsy (BMB) is performed. It doesn't make sense to do them if a patient is not in CR or near-CR since less sensitive measures can pick up the presence of myeloma cells in the bone marrow when there are "lots" of them.
As you mentioned, it has been the case that MRD testing has been done in some clinical trials for a few years now. (For multiple myeloma patients. MRD testing has been used longer in treating leukemia patients.) However, some myeloma centers are moving toward making MRD testing routine for patients who may be MRD negative. The head of the multiple myeloma department at MSK (Dr. Ola Landgren) mentioned to me a couple years ago that he is hoping to do just that at MSK. I don't know if that has happened yet.
I am in a clinical trial where I get tested for MRD once a year. My BMB for that test will be coming up around the end of August, so I'm keeping my fingers crossed that I'll still be MRD negative then!
I'd suggest asking your doctor whether you've been tested for MRD, and, if so, what the results were.
One other thing - although it's a slightly different question, there is another current thread about MRD that you might want to look at:
"Understanding my minimal residual disease" (started July 16, 2016)
Ron Harvot and JPC have both provided informative replies there.
Here's hoping you are MRD negative and stay that way for a long time!
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: How common is minimal residual disease (MRD) testing?
Excellent answers and input.
I thought I would chime in on the significance of MRD testing, to put its role (hopefully) in context. What I am about to mention I have heard for the first time only in the last couple of weeks.
Up until now, the primary mechanism by which a new drug or treatment approach has been approved was to show superior overall survival in one or several approved clinical trials. For newly diagnosed transplant-eligible patients (particularly without adverse risk), that duration has been shown to be improved recently into the range of 8 to 10 years. That creates a conundrum where the approval of new drugs are potentially slowed down. The research community has become a victim of its own success. To get better new drugs, a clinical trial would have to run for about that length of time to get good results, to show that the new drug is better than the existing drugs.
Dr. Ken Anderson and others have proposed an answer to this. He proposed that new clinical trials be designed with a "primary endpoint" (that is clinical trial jargon for the measureable aim of the trial) as the rate of achieving MRD negative status. Response can be evaluated in less than a year. There is arguably enough data on MRD in multiple myeloma at this time to "predict" that noticeably superior rates of MRD negative status will translate into not only improved progression-free survival, but eventually into improved overall survival as well.
Now for me, this would unquestionably be a good thing, despite the recent improvements and hope for good outcomes based on current treatments, the multiple myeloma still eventually comes back. Keeping up the pace of recent developments, particularly with new immunotherapy approaches, is important, particularly for the populations currently newly diagnosed or in their first or second remission.
I thought I would chime in on the significance of MRD testing, to put its role (hopefully) in context. What I am about to mention I have heard for the first time only in the last couple of weeks.
Up until now, the primary mechanism by which a new drug or treatment approach has been approved was to show superior overall survival in one or several approved clinical trials. For newly diagnosed transplant-eligible patients (particularly without adverse risk), that duration has been shown to be improved recently into the range of 8 to 10 years. That creates a conundrum where the approval of new drugs are potentially slowed down. The research community has become a victim of its own success. To get better new drugs, a clinical trial would have to run for about that length of time to get good results, to show that the new drug is better than the existing drugs.
Dr. Ken Anderson and others have proposed an answer to this. He proposed that new clinical trials be designed with a "primary endpoint" (that is clinical trial jargon for the measureable aim of the trial) as the rate of achieving MRD negative status. Response can be evaluated in less than a year. There is arguably enough data on MRD in multiple myeloma at this time to "predict" that noticeably superior rates of MRD negative status will translate into not only improved progression-free survival, but eventually into improved overall survival as well.
Now for me, this would unquestionably be a good thing, despite the recent improvements and hope for good outcomes based on current treatments, the multiple myeloma still eventually comes back. Keeping up the pace of recent developments, particularly with new immunotherapy approaches, is important, particularly for the populations currently newly diagnosed or in their first or second remission.
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JPC - Name: JPC
Re: How common is minimal residual disease (MRD) testing?
Good point, JPC! That's a tremendous potential benefit of minimal residual disease (MRD) testing.
Unfortunately, the fact that minimal residual disease testing is not standardized yet is a bit of a hurdle that we must get beyond before MRD testing is used as a surrogate for overall survival or even progression-free survival. I'm no expert, but it seems to me that this hurdle is almost more of a political hurdle than a technical hurdle. Like, just pick one way of doing it (for now) and move on.
But I've already spouted off from this soapbox before ...
Anyway, thanks for bringing up an important point.
Mike
Unfortunately, the fact that minimal residual disease testing is not standardized yet is a bit of a hurdle that we must get beyond before MRD testing is used as a surrogate for overall survival or even progression-free survival. I'm no expert, but it seems to me that this hurdle is almost more of a political hurdle than a technical hurdle. Like, just pick one way of doing it (for now) and move on.
But I've already spouted off from this soapbox before ...
Anyway, thanks for bringing up an important point.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: How common is minimal residual disease (MRD) testing?
Mike:
You are 200% correct in regards to your observation regarding standardization! However, keep in mind that it is not your job (or mine) to deal with that issue. We have enough on our plates! I hope that "the powers that be" are dealing with this issue in appropriate manner.
Best Regards
You are 200% correct in regards to your observation regarding standardization! However, keep in mind that it is not your job (or mine) to deal with that issue. We have enough on our plates! I hope that "the powers that be" are dealing with this issue in appropriate manner.
Best Regards
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JPC - Name: JPC
6 posts
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