Is Progress in MRD Testing Reshaping Doctor-Patient Conversations?

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Topics include: Treatments and Understanding

What is minimal residual testing (MRD)? Dr. Jesus Berdeja, a hematological oncologist from Sarah Cannon Reseach Institute, helps us understand the basics of MRD testing and discusses advances that are reshaping conversations about remissions. Can MRD testing predict and guide multiple myeloma treatment? Dr. Berdeja provides insights and speaks about the progress and challenges that lie ahead. 

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Berdeja:

So minimal residual disease, or MRD, is a way to actually take different types of modalities like flow cytometry or next-generation sequencing, which are much more sensitive techniques, to really find cells up to one in a million.  So if we cannot find in a million cells one myeloma cell, we consider that MRD negative to the power of 10 to the minus 6, and it's a much deeper remission than a complete remission.   

In myeloma, there actually is no standard for MRD.  MRD remains right now an investigational process, but there is a lot of data now looking at MRD itself, and it appears that by doing techniques like NGS or EuroFlow or next-generation flow where we can really detect cells down to one in a million knowing that this is a much deeper remission, it appears that patients who achieve that actually live longer.  And so the—although there is no standard that is definitely the goal, and it is starting to be incorporated in many practices.   

The problem is there's one—there are two caveats.  One is if you achieve MRD negativity that is a good thing.  You want to be there.  The problem is we don't know what to do with that result.  There is no data thus far that tells us that we can stop therapy. There's no data that tells us that we should add more therapy, and so it can be somewhat confusing just having this result when it doesn't even really change your management.  

And that's what I mean that it is not currently standard, but I believe in the next year or two we will have studies that will help guide us and MRD will become truly standard and eventually should be done on all patients with myeloma.  

MRD can be done by two major techniques.  One is by flow cytometry and next-generation sequencing.  Those are the two most dominant forms.  Flow cytometry can be very user dependent, and so a standardization is important.  It is a much easier technique to do because it can be done at basically any pathologist's office, but again doing it to a level where it truly stands for the same thing from one laboratory to the next is difficult.  So that is the problem with that.   

Next-generation sequencing is more standardized, but it does require that the specimens be sent to a centralized laboratory and often requires that a specimen be captured at the time of diagnosis, and oftentimes if that is not done, then it cannot be used to follow the patient subsequently.  So there are pros and cons to both techniques.  

There are several other modalities that are being tested including circulating DNA, perhaps being able to do this and capture this in the bloodstream instead of having to go into the bone marrow, but as of today the standard of care—that likely will become the standard of care I should say, is still assessment of the bone marrow by flow or NGS.  

MRD is not something that can be recommended as standard of care, but I think it's definitely a piece of information no different than any other laboratory test.  The bone marrow results or imaging that helps to determine the extent of your remission, and it is important to discuss that with your physicians in terms of should we do this testing?  What will we do with the results?  Do you want to know?  

If you get a positive result, it can be scary for the patient, but again not knowing what it means in the long term in terms of changes is therapy it's unclear to know what should—what should be recommended.  But I think it's definitely a conversation you have individually with your doctor as we're all different people, and sometimes having that knowledge is power. But, again, it's definitely we're at a time where the conversation should be had.  It if it can be done, it should be done, but realize that the—it may not change your management at this time.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 20, 2019