ASH Clinical News ACN_4.4_SUPP_Digital Version | Page 43

“My own personal conclusion [about] the controversy is
we should be aiming for molecular remission, because it’s the
prerequisite for a cure,” Dr. Davies concluded. “However, we do
need to understand the MRD cells that we are trying to elimi-
nate in more detail.”
MRD is a valuable tool, she contends, but measuring it is not
enough. “Learning about those cells is going to teach us how we
can therapeutically manipulate them so we can induce a cure,”
Dr. Davies said. For instance, recent evidence has suggested that
the microenvironment is enabling these treatment-resistant
cells. “We need to figure out how we’re going to get rid of this
microenvironment protection because, as those cells continue
[to survive] and mutate, the inevitable is going to happen –
patients are going to relapse.”
”We can all agree that
MRD negativity is
associated with a better
prognosis, [but] what
does this mean for
routine clinical practice?”
—FAITH E. DAVIES, MBBCH, MD
Too Long, Too Short, or Just Right?
Heinz Ludwig, MD, from the Wilhelminen Cancer Research
Institute in Vienna, Austria, posed the question of treatment
duration among patients with MM, which has become a crucial
issue in the myeloma treatment landscape.
Dr. Ludwig started by reviewing the fundamentals of
treatment decision-making for patients with MM: patient-
specific characteristics (i.e., age, fitness, and comorbidities) and
disease-specific characteristics (i.e., cytogenetic profile and rate
of disease progression). “When we go back 10 years, let’s say
in 2007, the treatment paradigm was quite straightforward in
MM: We had induction therapy, transplant in young patients,
fixed-duration therapy (6, 9, or 12 months) for older patients,
less-intense therapy for frail patients, and a couple of treatment
cycles for relapsed patient