Rafael Fonseca MDChair, Department of Medicine Mayo Clinic in AZ
MRD Implications for High risk Disease
Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida
Mayo Clinic College of MedicineMayo Clinic Comprehensive Cancer Center
Biomarker
• The disease with best biomarkers ever!• Personalized medicine is now based on
understanding biology and genetics• MRD is the ultimate frontier to adjust
and personalize management of MM
Is myeloma like AP CML
Figure 2. OS difference among different inter-quartile groups by (a) CINGEC, (b) GII of Mayo patient aCGH data and (c) CINGEC, (d) GII of UAMS patient.
Chung T-H, Mulligan G, Fonseca R, Chng WJ (2013) A Novel Measure of Chromosome Instability Can Account for Prognostic Difference in Multiple Myeloma. PLoS ONE 8(6): e66361. doi:10.1371/journal.pone.0066361http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066361
Figure 2. OS difference among different inter-quartile groups by (a) CINGEC, (b) GII of Mayo patient aCGH data and (c) CINGEC, (d) GII of UAMS patient.
Chung T-H, Mulligan G, Fonseca R, Chng WJ (2013) A Novel Measure of Chromosome Instability Can Account for Prognostic Difference in Multiple Myeloma. PLoS ONE 8(6): e66361. doi:10.1371/journal.pone.0066361http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066361
del 17 p, sCR prior to ASCT
Clinical Scenarios
MM
Persistent diseaseClonal enrichment
Quiescent MM cellsLow proliferation
CR/sCR
MM
Persistent diseaseClonal enrichment
Quiescent MM cellsLow proliferation
MGUSSMM
Clonal non malignant
Standard
Observe
Treat?
Observe?
Back off!
Myeloma is always preceded by MGUSWill not address subclone principles
MGUS
SMM
MM
MYC
Clinical ScenariosWhen to test for MRD?
DiagnosisKRD
SCT Maintenance
Relapse(e.g. ASPIRE)
CR2CRsCR
Prognosis Decide Monitor Value
Sagar’s iceberg
Better Icerberg Than Sagar’s?
Cure 0
1x108
1x1012
1x104
Diagnosis
CR
Flow
NGS
