Immune MRD Status Informs Tumor MRD Outcome Prognostication in Patients with Multiple Myeloma on Lenalidomide
Ross S Firestone1, Anish K Simhal2, Devin McAvoy3
1Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Summary
Measurable residual disease (MRD) resurgence in multiple myeloma patients on lenalidomide maintenance may not always predict progression. Immune cell profiling offers new insights into predicting relapse or durable remission.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Lenalidomide maintenance is standard for newly diagnosed multiple myeloma (MM) post-induction therapy.
- Measurable residual disease (MRD) negativity predicts outcomes, but managing MRD resurgence (MRDres) is unclear.
Purpose of the Study:
- To evaluate the clinical utility of serial MRD assessments in MM patients on lenalidomide maintenance.
- To explore the role of T cell profiling in predicting outcomes based on MRD status.
Main Methods:
- Phase 2, single-arm study of 5-year continuous lenalidomide maintenance.
- Exploratory peripheral blood T cell profiling using high-dimensional spectral cytometry.
Main Results:
- Patients with MRDres had shorter progression-free survival (PFS) than MRD-negative patients.
- However, 64% of patients with MRDres did not progress by last follow-up.
- Immune signatures, including T cell profiles, predicted early relapse or durable remission.
Conclusions:
- An "immune-MRD" status integrating T cell profiles shows predictive potential.
- This approach can differentiate patients with MRDres who progress from those who maintain remission.
