MRD in Multiple Myeloma

Multiple myeloma (MM) is characterised by clonal proliferation of malignant plasma cells (PC) in the bone marrow, serum/urine monoclonal immunoglobin and organ disfunction. MM remains incurable, despite significant improvements with novel therapies. The depth of response according to International Myeloma Working Group (IMWG) response criteria and by Minimal Residual Disease (MRD) detection is associated with survival. MRD is a more sensitive measure of disease burden than traditional definitions of response and MRD-negative status predicts prolonged overall and progression-free survival in MM patients, regardless of disease staging and eligibility for transplant. The IMWG recommends an MRD-sensitivity threshold of at least 10-5 using next-generation sequencing (NGS) or next-generation flow cytometry (NGF). The sensitivity of multiparametric flow cytometry is usually inferior to sequencing, but with the correct technical approach the sensitivity of this method can be similar to sequencing.

The aim of this project is to monitor the effect of therapy by evaluating the degree of response through MRD quantification, comparing NGS and NGF. These methods are used with different expertise and few studies have thoroughly investigated whether there are clear advantages of one over the other.