Minimal Residual Disease in Multiple Myeloma: Potential for Blood-Based Methods to Monitor Disease

Abstract

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Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant

“…Thus, bone marrow assessment for tumor plasma cell (TPC) burden at diagnosis and response monitoring has become an integral part of laboratory work‐up in PCNs. However, BM‐TPC enumeration has several challenges that limit accurate and reproducible results, including patchy involvement, hemodilution, TPC adherence to lipid‐enriched spicules, and so forth 4,14–17 . In addition, BM aspiration is a painful procedure and may not be feasible to perform multiple times for sequential response monitoring 17–19 .…”

“…Studies have demonstrated that CTPC possesses stem cell‐like features and altered genetic characteristics with high clonogenic potential 18,19,24–28 . The utility of periodic MRD assessment is increasing in myeloma with emerging MRD‐related treatment decisions 15,17,29–32 . The ability to detect MRD in the PB (PBMRD) can improve ease of testing and holds the potential to decrease the number of painful BM procedures 18 .…”

“…However, BM‐TPC enumeration has several challenges that limit accurate and reproducible results, including patchy involvement, hemodilution, TPC adherence to lipid‐enriched spicules, and so forth. 4 , 14 , 15 , 16 , 17 In addition, BM aspiration is a painful procedure and may not be feasible to perform multiple times for sequential response monitoring. 17 , 18 , 19 It also has limited use in assessing extramedullary disease.…”

“… 4 , 14 , 15 , 16 , 17 In addition, BM aspiration is a painful procedure and may not be feasible to perform multiple times for sequential response monitoring. 17 , 18 , 19 It also has limited use in assessing extramedullary disease. Notably, current International Myeloma Working Group (IMWG) guidelines indicate BMMRD assessment only in patients achieving complete remission (CR) and restrict its applicability to patients who could not achieve CR.…”

“… 18 , 19 , 24 , 25 , 26 , 27 , 28 The utility of periodic MRD assessment is increasing in myeloma with emerging MRD‐related treatment decisions. 15 , 17 , 29 , 30 , 31 , 32 The ability to detect MRD in the PB (PBMRD) can improve ease of testing and holds the potential to decrease the number of painful BM procedures. 18 Therefore, assessing PBMRD can be ideal for monitoring sequential therapeutic response.…”