Minimal residual disease negativity using deep sequencing is a major prognostic factor in multiple myeloma

The introduction of novel agents has led to major improvements in clinical outcomes for patients with multiple myeloma. In order to shorten evaluation times for new treatments, health agencies are currently examining minimal residual disease(MRD) as a surrogate endpointin clinical trials. We assessed the prognostic value of MRD, measured during maintenance therapyby next-generation sequencing. MRD negativity was defined as the absence of tumor plasma cell within 1,000,000 bone marrow cells ( -6 ). Data were analyzed from a recent clinical trial that evaluated the role of transplantation in newly diagnosed myeloma patients treated with lenalidomide, bortezomib, and dexamethasone (RVD). MRD negativity was achieved at least once during maintenance in 127 patients (25%). At the start of maintenance therapy, MRD was a strong prognostic factor for both progression-free survival(adjusted hazard ratio, 0.22; 95% confidence interval, 0.15 to 0.34; P