Ultra-sensitive MRD assessment in MM with BloodFlow

Assessing minimal residual disease (MRD) with BloodFlow in peripheral blood demonstrated to be able to detect MRD with a sensitivity down to 10^-8 in patients with multiple myeloma (MM). Furthermore, MRD assessment in peripheral blood was prognostic of disease outcomes if patients followed maintenance therapy or if they were under observation.

“Since bone marrow MRD assessment is an invasive procedure, periodic evaluation is precluded,” said Dr Laura Notarfranchi (University of Parma, Italy). “Assessing MRD in peripheral blood could overcome this limitation. However, the sensitivity of peripheral blood assessment needs to be increased to 10^-7 or 10^-8 to reduce the number of false negatives.”

Dr Notarfranchi and colleagues first confirmed that MRD assessment in peripheral blood using next-generation flow (NGF) was prognostic of progression-free survival in patients with MM (cohort of 138 patients with MM) who were enrolled in the GEM2014MAIN trial (NCT02406144]) [1]. However, MRD assessment in bone marrow was more sensitive with 33 MRD-positive patients detected versus 15 on placebo (P<0.001).

Next, the researchers assessed MRD in 353 samples of peripheral blood via a novel method called BloodFlow and found this was more sensitive than using NGF, detecting MRD-positive cases with a sensitivity down to 6 x 10^-8. In total, 33 MRD-positive cases were detected via BloodFlow and 14 via NGF. Furthermore, BloodFlow showed a negative predictive value of 77%, with 41 out of 199 paired samples (20.5%) showing a false negative result in BloodFlow compared with NGF in bone marrow. “MRD assessment during induction therapy or intensification of therapy was more frequently associated with false negative results in peripheral blood assessment,” explained Dr Notarfranchi.

Finally, a preliminary analysis of 33 patients of the GEM2014MAIN trial that were receiving maintenance therapy or were under observation showed that MRD assessment via BloodFlow in peripheral blood was prognostic of progression-free survival, suggesting that periodic evaluation of MRD via BloodFlow in peripheral blood may help physicians in the monitoring of these patients, although the clinical relevance still has to be proven.

1. Notarfranchi L, et al. Ultra-Sensitive Assessment of Measurable Residual Disease (MRD) in Peripheral Blood (PB) of Multiple Myeloma (MM) Patients Using Bloodflow. Abstract 865, ASH 64^th Annual Meeting, 10–13 December 2022, New Orleans, LA, USA.

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Posted on 20 February 2023