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Meta-analysis Shows Association of Minimal Residual Disease–Negative Status With Improved Survival in Multiple Myeloma

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Key Points

  • MRD-negative status was associated with significantly better progression-free and overall survival among all patients with newly diagnosed multiple myeloma.
  • MRD-negative status was associated with significantly better progression-free and overall survival among patients with complete response.

In a meta-analysis reported in JAMA Oncology, Munshi et al found that minimal residual disease (MRD)-negative status was associated with improved survival in patients with newly diagnosed multiple myeloma. For the analysis, a literature search identified 21 English language articles published between January 1990 and January 2016 that reported MRD status and progression-free survival or overall survival in at least 20 patients following treatment.

Effect of MRD Status

Association with MRD was reported for progression-free survival in 14 studies (n = 1,273; 660 MRD-negative, 613 MRD-positive) and for overall survival in 12 studies (n = 1,100; 599 MRD-negative, 501 MRD-positive).

Compared with MRD-positive status, MRD-negative status was associated with better progression-free survival (hazard ratio [HR] = 0.41, P < .001) and overall survival (HR = 0.57, P < .001). Median progression-free survival was 54 months vs 26 months, and median overall survival was 98 vs 82 months.

Data on the impact of conventional complete response were available from 5 studies (n = 574; 396 MRD-negative, 178 MRD-positive) for progression-free survival and 6 studies (n = 616; 430 MRD-negative, 186 MRD-positive) for overall survival. In patients achieving complete response, MRD-negative status was associated with better progression-free survival (HR = 0.44, P < .001) and overall survival (HR = 0.47, P < .001). Median progression-free survival was 56 vs 34 months, and median overall survival was 112 vs 82 months.

Tests of heterogeneity showed no significant differences among studies for progression-free or overall survival.

The investigators concluded: “Minimal residual disease-negative status after treatment for newly diagnosed [multiple myeloma] is associated with long-term survival. These findings provide quantitative evidence to support the integration of MRD assessment as an end point in clinical trials of [multiple myeloma].”

The study was supported by grants from the National Institutes of Health, the Medical Research Council UK, and Celgene.

Nikhil C. Munshi, MD, of Dana-Farber Cancer Institute, is the corresponding author of the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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