ASH 2019: Follow the Yellow Brick Road… to Minimal Residual Disease Negativity in Myeloma

By Elise Martin

Each December in the weeks following that year’s ASH Conference, the Multiple Myeloma Oncology Team at Dana Farber Cancer Institute hosts a symposium for myeloma patients (and staff) at which they share relevant information from ASH on current and promising treatment strategies and advances in the field.  In December 2018, one of the topics highlighted was the emergence of “minimal residual disease” (MRD) as an important clinical benchmark of disease status, the desired treatment outcome for patients.  

I should quickly add a disclaimer here - I have no medical background other than life’s experiences, and at the time of that symposium was only 18 months into the world of myeloma, so likely misunderstood some of the information and definitely heard all of it through the filter of my husband’s 18 month experience as a myeloma patient.

My memory of the discussion on that topic is that the establishment of minimal residual disease as benchmark was particularly useful in evaluating efficacy of new myeloma treatment protocols.  I also remember (because of course it was most relevant to my husband’s disease status at the time) that a few of the oncologists presenting at the symposium cautioned the audience that they were not suggesting “MRD-negative or bust” – that there were many patients at Dana Farber whose disease remained stable in “very good partial remission” (VGPR) for many years without ever reaching “complete remission” (CR).  My husband, who was in VGPR at that time, 8 months after his autologous stem cell transplant (ASCT), and I took that cautionary advice to heart and left the symposium without any sense of “disease status inadequacy” that we otherwise might have felt about his very good partial response, minimal residual disease-positive status.

Fast forward to December 2019, and, a year deeper into the experience of “myeloma as life partner”, my husband and I, who have become Myeloma Coaches through the Myeloma Crowd Crowdcare Foundation, are at ASH 2019, attending sessions and learning as much as we can about the disease and its treatment so that we may be better-informed coaches and patient/partner team.  

Minimal residual disease is everywhere!  Every session we have attended has included – indeed focused on – treatment protocols that increase the number of patients achieving minimal residual disease-negative status.  Being minimal residual disease-negative is correlated with better progression-free survival (PFS) and overall survival (OS) for myeloma patients.  We heard the question raised at “Approaches to Achieve the Best Possible Outcomes in Myeloma” session on Friday, December 6th - “Does MRD=cure?” That myeloma disease treatment has advanced to the point where that question is being asked is a very good thing! 

The question that lingers on our minds now is, what is our “yellow brick road” to become minimal residual disease negative?  We will go back to Dana Farber with this question, for sure, but we are also mindful of last year’s cautionary advice about stable disease being an “acceptable place to hang around”.  We feel reassured after listening to Suzanne Lentzsch, MD, PhD, (Division of Hematology/Oncology, Columbia University, New York, NY ) describe a fairly deep toolkit of drugs currently approved for patient treatment at second, third and beyond relapses in her presentation at “Challenges in Myeloma Therapy” session on Sunday morning, December 8th.  

Thanks to our Myeloma Coach ASH 2019 sponsors: