Pan-Pacific Multiple Myeloma Working Group consensus: MRD-adapted therapy in MM

Guidelines and consensus recommendations from the Pan-Pacific Multiple Myeloma Working Group (PPMMWG) on the use of measurable residual disease (MRD)-adapted therapy in multiple myeloma (MM) were published in Clinical Hematology International by Chen et al. A modified Delphi process involving a systematic review and anonymous online voting by 17 hematology and oncology experts generated seven consensus statements across four domains: treatment goals in the era of cluster of differentiation 38 (CD38)-based therapy, MRD-guided clinical decision-making, standardization of MRD detection, and integration of novel technologies. 

Key data: MRD testing is recommended in patients achieving complete response (CR), particularly following effective CD38-based therapy, and should be incorporated into the treatment evaluation process alongside imaging, bone marrow (BM) assessment, and peripheral blood assays. The frequency and timing of MRD assessment should be tailored to the treatment phase, with testing every 6 months for MRD-positive patients and every 12 months for MRD-negative patients during maintenance. CD38-based therapy is recommended as active maintenance regardless of MRD status, with potential relative benefit for MRD-positive or high-risk patients. Dynamic MRD monitoring is recommended, next-generation flow (NGF)/next-generation sequencing (NGS) are deemed interchangeable for prognostic assessment, and peripheral residual disease (PRD) detection is a key direction for future disease monitoring. 

Key learning: These consensus recommendations support dynamic MRD-adapted disease monitoring as a practical framework for risk stratification and individualized treatment decisions in MM.