Maintenance therapy discontinuation in patients with deep measurable residual disease (MRD) negativity (<10⁻⁶ or <10⁻⁷) is associated with low rates of disease resurgence in patients with multiple myeloma (MM), according to results from the MRD2STOP trial published in Blood Cancer Journal.
“Discontinuation of maintenance therapy in patients with MM and multimodal MRD < 10−6 resulted in a low rate of disease progression or MRD resurgence,” the authors wrote.
Specifically, the results showed that for patients with MM with multimodal MRD < 10−6 who underwent discontinuation of maintenance therapy, the estimated 3-year progression-free survival (PFS) was 85% and even higher (92%) for those with MRD < 10−7 using a CD138-positive-selected assay, regardless of induction regimen, receipt of autologous stem cell transplant (ASCT), or maintenance therapy.
Although no MRD assay is currently validated to provide 10−7 sensitivity, the authors showed that the CD138-positive-selected NGS 10−7 assay was feasible and detected MRD when the standard 10−6 assay did not.
“We propose that MRD < 10−7 might further improve upon existing assays to guide earlier discontinuation of maintenance therapy or provide justification to forgo maintenance entirely,” the authors wrote.
The MRD2STOP trial was a prospective, single-institution trial evaluating maintenance therapy cessation guided by MRD negativity in MM. Eligible patients were 18 years of age and older with MM who had received at least one year of single-maintenance therapy at the time of screening. In total, 45 evaluable patients discontinued maintenance therapy and the median age of enrolled patients was 66 years.
“Cost savings from the discontinuation of maintenance therapy could be substantial,” the authors noted, calling for validation of this by a formal cost savings analysis.
Reference
Derman BA, Major A, Cooperrider J, et al. Discontinuation of maintenance therapy in multiple myeloma guided by multimodal measurable residual disease negativity (MRD2STOP). Blood Cancer J. 2024;14(1):170. 2024. doi:10.1038/s41408-024-01156-x
