In our fifth MCRI episode featuring the top 10 proposals for high-risk multiple myeloma, Dr. Bruno Paiva describes his study of chemo-resistant myeloma cells after therapy using new, more sensitive minimal residual disease (MRD) monitoring. With the abundance of newer therapies, myeloma doctors have an opportunity to use specific treatments for certain patients, but this requires deeper knowledge about the biology of the tumor cells and better tools to monitor response to treatment. In his study, he aims to answer important questions like: Why do high-risk patients have similar MRD response rates but inferior survival? Why are some patients MRD positive and still have great outcomes? Is it because of the biology of the chemo-resistant cell? Can this information lead to tailored treatment and better survival for high-risk patients? If all patients have several different types of myeloma cells in them at the time of diagnosis, which cells are surviving after high-dose chemo?  In a clinical trial with 100 high-risk patients, he will use the next-generation flow MRD test after chemo to study the tumor cells that remain to hopefully find an attractive target. This is the first time that a newer, more evolved MRD test will not only measure depth of response in a more sensitive way, but also look at the biology of the cells. The Myeloma Crowd Radio Show with Dr. Bruno Paiva, PhD