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Minimal Residual Disease in Multiple Myeloma: Impact on Response Assessment, Prognosis and Tumor Heterogeneity

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Biological Mechanisms of Minimal Residual Disease and Systemic Cancer

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1100))

Abstract

Multiple Myeloma (MM) therapy has evolved rapidly over the past decade. With current multidrug combinations and autologous transplant, rates of overall response exceed 90% and complete response (CR) more than 50% in some studies. Unfortunately, despite higher rates of CR, relapse rates remain high suggesting that persistent disease may not be measured by current techniques. Traditionally, response rates were defined by urine and serum protein electrophoresis, immunofixation and histopathological absence of clonal plasma cells in the bone marrow. Currently, there are several validated sensitive assays to evaluate for MRD (minimal residual disease); multiparameter flow cytometry (MFC) including nextgeneration flow cytometry (NGF), next-generation sequencing (NGS), and allele specific oligonucleotide quantitative polymerase chain reaction (ASO-qPCR). These methods have provided a means to quantitatively assess residual disease and accurately prognosticate PFS and OS in myeloma. In this chapter, we will discuss the current techniques for MRD detection as well as describe techniques that are emerging for improved characterization of drug resistant residual populations that could be adapted for MRD monitoring in the future. While improved therapies are able to eradicate the dominant clone, resistant sub-clones persist and remain undetectable even by MRD techniques. Characterization of these clones will help design therapies against drug-resistant clones and move us closer to a cure in MM.

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  1. Author contributed equally with all other contributors.Natalie Berger and Samir Parekh

Authors and Affiliations

  1. Hematology/Oncology Fellowship Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Natalie Berger

  2. Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Seunghee Kim-Schulze

  3. Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Samir Parekh

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  1. Natalie Berger
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  2. Seunghee Kim-Schulze
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  3. Samir Parekh
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Correspondence to Samir Parekh .

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Editors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Department of Otolaryngology, Department of Oncological Sciences, Tisch Cancer Institute, Black Family Stem Cell Institute, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Julio A. Aguirre-Ghiso

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Berger, N., Kim-Schulze, S., Parekh, S. (2018). Minimal Residual Disease in Multiple Myeloma: Impact on Response Assessment, Prognosis and Tumor Heterogeneity. In: Aguirre-Ghiso, J. (eds) Biological Mechanisms of Minimal Residual Disease and Systemic Cancer. Advances in Experimental Medicine and Biology, vol 1100. Springer, Cham. https://doi.org/10.1007/978-3-319-97746-1_9

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