A meta-analysis involving over 3,000 patients has validated minimal residual disease (MRD) status as a surrogate endpoint for progression-free survival (PFS) in newly diagnosed multiple myeloma (NDMM). The study, encompassing six randomized trials, demonstrates a strong correlation between MRD negativity and improved PFS, potentially accelerating drug development in this challenging hematologic malignancy.
The research addresses the increasing need for faster endpoints in multiple myeloma trials, as therapeutic advances have extended survival times, necessitating lengthy studies when using survival outcomes as primary endpoints. The meta-analysis, adhering to principles outlined at the 2013 United States Food and Drug Administration workshop on MRD in acute myeloid leukemia, sought to determine if MRD status could serve as a valid surrogate for PFS.
The analysis included 3283 patients and 2208 MRD samples from six randomized studies. MRD negativity rates in the included studies ranged from 0.06 to 0.70. The key finding was a strong correlation between the treatment effect on the odds ratio for MRD-negative response and the hazard ratio for PFS, with a coefficient of determination (R^2) of 0.97 for the weighted regression line. This high correlation suggests that achieving MRD negativity is a reliable indicator of improved PFS.
The study imputed MRD status for samples not initially measured, considering patients excluded from planned MRD assessment as MRD-positive. This imputation method aimed to account for missing data and provide a comprehensive analysis of the available evidence.
These results support the claim that MRD status can be used as a surrogate for PFS in NDMM, potentially streamlining the drug development process by allowing for earlier assessment of treatment efficacy. The findings have significant implications for clinical trial design and regulatory decision-making in multiple myeloma.
