Clinical implications of minimal residual disease monitoring in multiple myeloma.

Abstract

Recent advances in multiple myeloma (MM) therapy, including quadruplet regimens, chimeric antigen receptor T cell therapies, and bispecific antibodies, have dramatically improved outcomes, necessitating disease assessment tools that are more sensitive than the conventional serological criteria. Consequently, minimal residual disease (MRD) negativity has emerged as a robust surrogate endpoint for survival. This review summarizes the current methodologies for MRD detection, primarily next-generation sequencing (NGS) and next-generation flow (NGF), and evaluates the prognostic significance of MRD negativity across the disease spectrum. We herein discuss key data from major clinical trials in both newly diagnosed and relapsed/refractory settings, highlighting the high rates of MRD negativity achieved with novel therapeutic classes. A central focus is the evolving paradigm of MRD-adapted therapy, which utilizes dynamic MRD assessment to guide treatment decisions by allowing escalation in high-risk patients or de-escalation to reduce toxicity in deep responders. In addition, we address the optimal timing for MRD testing and the challenges of integrating these assessments into routine clinical practice. In conclusion, this review emphasizes the growing utility of MRD as not only a prognostic biomarker but also a critical tool to drive personalized treatment strategies and further enhance long-term outcomes in MM patients.