Is This the Time to Introduce Minimal Residual Disease in Multiple Myeloma Clinical Practice?
Cet article passe en revue les travaux récents sur l'intérêt de la détection d'une maladie résiduelle minimale pour la prise en charge clinique des patients atteints d'un myélome multiple
Increasing therapeutic options and prolonged survival in multiple myeloma (MM) have raised interest on the concept of depth of response and its importance to predict patients' outcome. While the efficacy of current treatment approaches has greatly improved in the last decade, the definition of complete response (CR) remains unaltered and continues to use conventional serological and morphological techniques. That notwithstanding, there is growing interest in minimal residual disease (MRD) monitoring, which has emerged in recent years as one of the most relevant prognostic factors in MM. MRD can be assessed both inside (e.g., immunophenotypic and molecular techniques) and outside the bone marrow (e.g., PET-CT). Here, we focus on flow- and molecular-based assays by which different cooperative groups have demonstrated the efficacy of MRD assessment to predict outcomes even among patients in CR, and irrespectively of disease risk. Although, further standardization is still required, the time has come to implement MRD monitoring in prospective clinical trials as a sensitive tool to evaluate treatment efficacy and for risk-adapted treatment, particularly in the consolidation and maintenance settings. Here we present a comprehensive and critical review on the methodological aspects, specific characteristics, as well as clinical significance of MRD monitoring by flow cytometry, PCR and next generation sequencing.
Clinical Cancer Research , résumé, 2015