Minimally Invasive Assessment of Peripheral Residual Disease During Maintenance or Observation in Transplant-Eligible Patients With Multiple Myeloma
Authors: Lasa Marta , Notarfranchi Laura , Agullo Cristina , Gonzalez Carmen , Castro Sergio , Perez Jose J. , Burgos Leire , Guerrero Camila , Calasanz Maria Jose , Flores-Montero Juan , Oriol Albert , Bargay Joan , Rios Rafael , Cabañas Valentin , Cabrera Carmen , Martinez-Martinez Rafael , Encinas Cristina , De Arriba Felipe , Hernandez Miguel-Teodoro , Palomera Luis , Orfao Alberto , Martinez-Lopez Joaquin , Mateos Maria-Victoria , San-Miguel Jesus , Lahuerta Juan Jose , Rosiñol Laura , Blade Joan , Cedena Maria Teresa , Puig Noemi , Paiva Bruno ,   on behalf of the PETHEMA/GEM Cooperative Group, Casanova María , Couto Carmen , Carrillo Estrella , González Esther , González Ana Pilar , Sampol Antonia , Suárez Alexia , Montes Carmen , Calle Mª del Carmen , Casado Luís Felipe , de Miguel Dunia , Ibáñez Ángela , Labrador Jorge , García Aránzazu , Escalante Fernando , Aguilar Carlos , Escoda Lourdes , Sureda Ana María , Motlló Cristina , González Yolanda , Monreal Eugenia , Soler Juan Alfonso , Granell Miquel , Cabezudo Elena , Mª Martí Josep , García Antonio , Gironella Mercedes , Dios Ana , Méndez José Ángel , González Marta Sonia , Nájera Mª José , Peñalver Francisco Javier , Bravo Pilar , Hernández José Ángel , de Oteyza Jaime Pérez , del Barrio Rebeca Iglesias , de la Guía Ana López , Alegre Adrián , Krsnik Isabel , Ruíz Elena , Blanchard Mª Jesús , Íñigo Belén , Giménez Eugenio , Riaza Rosalía , Prieto Elena , Romera Marta , Mª Moraleda Jose , Prósper Felipe , Mª Arguiñano Jose , Puente María , Gutiérrez Xabier , Teruel Ana Isabel , Rivas Paz , Jarque Isidro , Fernández Ángel , Santamaría Amparo , Martínez Carmen 
Published: October 2024

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in
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In multiple myeloma (MM), measurable residual disease (MRD) is assessed in bone marrow (BM). However, less invasive evaluation of peripheral residual disease (PRD) in blood could be advantageous and less cumbersome. We investigated the prognostic value of PRD monitoring after 24 cycles of maintenance in 138 transplant-eligible patients with MM enrolled in the GEM2012MENOS65/GEM2014MAIN clinical trials. PRD was assessed using next-generation flow (NGF) and mass spectrometry (MS). Positive PRD by NGF in 16/138 (11.5%) patients was associated with a 13-fold increased risk of progression and/or death; median progression-free survival (PFS) and overall survival (OS) were 2.5 and 47 months, respectively. Considering patients' MRD status in BM as the reference, PRD detection using NGF showed positive and negative predictive values of 100% and 73%, respectively. Presence of PRD helped identifying patients at risk of imminent progression among those with positive MRD in BM. Patients with undetectable PRD according to both NGF and MS showed 2-year PFS and OS rates of 97% and 100%, respectively. In multivariate analyses including the Revised International Staging System and the complete remission status, only MRD in BM and PRD by NGF showed independent prognostic value for PFS. This study supports the use of less invasive PRD monitoring during maintenance or observation in transplant-eligible patients with MM.