PFS, MRD, and Treatment Duration in Multiple Myeloma

Dr. Saad Usmani and Dr. Shaji Kumar discuss how sustained MRD negativity and long-term progression-free survival may inform future treatment strategies for patients with newly diagnosed multiple myeloma. They consider the relationship between sustained MRD negativity and durable disease control, particularly in transplant-ineligible patients, who represented approximately three-fourths of the CEPHEUS population. Dr. Kumar discusses the potential for MRD status to guide treatment discontinuation in future prospective studies, noting that standard-risk patients with sustained MRD negativity may be candidates for treatment cessation, while patients with high-risk disease may require deeper and more sustained MRD negativity before discontinuation can be considered. The experts emphasize that these approaches remain investigational and require prospective validation. The conversation then turns to the potential role of BCMA-directed therapies as consolidation or maintenance strategies and the evolving treatment approach for patients aged 65 to 80 years. They also discuss practical use of weekly bortezomib and treatment de-escalation when neuropathy or other tolerability concerns arise, while considering the long-term efficacy of daratumumab-based therapy.