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Real-World MRD Assessment in B-Cell ALL, Multiple Myeloma

April 08, 2020

The CLO20-035 study shed light on real-world minimal residual disease (MRD) assessment and trends in B-cell acute lymphoblastic leukemia (ALL) and multiple myeloma.

Results of the study were published in JNCCN (online March 20, 2020; doi:10.6004/jnccn.2019.7476).

MRD assessment is currently recommended within several lymphoid cancer National Comprehensive Cancer Network (NCCN) guidelines, including multiple myeloma, ALL, and chronic lymphocytic leukemia. While MRD findings are often reported within clinical trials, limited data exist on patient MRD testing patterns in the real-world care setting.

Audrey Demaree, PharmD, Adaptive Biotechnologies Corp (Seattle, WA), and colleagues sought to characterize the use of MRD assessment through clonoSEQ—the only Food and Drug Administration authorized MRD test available for bone marrow assessment in patients with B-cell ALL and multiple myeloma—in patients with such malignancies in the real-world care setting. The study population included a de-identified internal dataset of clonoSEQ clinical samples from January 2018 to October 2019. Patients with multiple myeloma (n = 1369) or B-cell ALL (n = 704) and a trackable sequence identified in a baseline clonality assessment were included in the analysis.

Researchers considered demographics, MRD testing patterns, and deepest level of MRD response in the analysis. They noted that the age distribution of patients with MRD testing performed was generally consistent with epidemiologic data.

Over the study time period, 47.5% of patients with multiple myeloma and 78.4% of patients with B-cell ALL were found to have reached an MRD response of at least 10-5. Additionally, 30.6% and 68.7% of patients, respectively, achieved a response of below 10-6.

In their concluding remarks, authors of the study noted that the real-world analysis demonstrated the growing use of MRD assessment in routine patient management and showed consistency with NCCN guidelines. “Given the association between MRD levels and long-term outcomes demonstrated across clinical trials and meta-analyses in lymphoid cancers, the ability to capture and report patient MRD values using a quantitative and standardized assay in a large real-world population presents important opportunities for understanding lymphoid cancer population health, and performing comparative effectiveness and other real-world evidence studies,” they wrote.—Zachary Bessette

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