Minimal residual disease (mrd) in multiple myeloma: prognostic and therapeutic implications (including imaging)

MRD is a powerful predictor of survival outcomes in myeloma regardless of type of therapy, line of therapy, clinical stage and biological risk. MRD may be assessed by flow cytometry, based on aberrant plasma cell phenotypes or next generation sequencing approaches, based upon unique immunoglobulin gene sequences and assays with a minimum sensitivity of 10-5 are recommended. MRD is best considered as a continuous prognostic variable as sequential improvements in outcome are demonstrable with each log depletion of disease.