A new meta-analysis indicates that achieving minimal residual disease (MRD) negativity is strongly associated with improved progression-free survival (PFS) in multiple myeloma (MM) patients. This finding supports the use of MRD negativity as an early endpoint in clinical trials, potentially accelerating the approval of new therapies. The study, published recently, analyzed data from multiple phase 2 and 3 randomized controlled trials.
The meta-analysis included eight studies involving 4907 newly diagnosed MM patients. The trial-level association between MRD negativity and PFS showed R2 values of 0.67 (95% CI, 0.43-0.91) and 0.84 (0.64 to >0.99) at the 12-month time point. Individual-level analysis demonstrated a global odds ratio (OR) of 4.02 (95% CI, 2.57-5.46) between 12-month MRD negativity and PFS in newly diagnosed MM.
MRD as a Predictive Endpoint
In relapse/refractory MM, the meta-analysis included four studies. The individual-level association between 12-month MRD negativity and PFS resulted in a global OR of 7.67 (4.24-11.10). These results suggest that a treatment effect on MRD is reasonably likely to translate into a treatment effect on PFS.
The study authors noted that estimating PFS and overall survival superiority in MM clinical trials has become more challenging due to improved patient outcomes with novel therapeutics. Identifying earlier endpoint surrogates predictive of long-term clinical benefit is crucial. MRD negativity has emerged as a common intermediate endpoint with prognostic value in MM.
Implications for Drug Development
The findings align with the US Food and Drug Administration (FDA) guidance on using MRD as a clinical endpoint. The meta-analysis supports the idea that MRD negativity can be used to support accelerated approval, expediting the availability of new drugs to patients with MM. This is particularly important given the unmet need for more effective therapies in both newly diagnosed and relapsed/refractory MM settings.
The meta-analysis evaluated MRD negativity as an early endpoint reasonably likely to predict long-term clinical benefit, based on the FDA guidance. Eligible studies were phase 2 or 3 randomized controlled clinical trials measuring MRD negativity as an endpoint in patients with MM, with follow-up of ≥6 months following an a priori-defined time point of 12 ± 3 months after randomization.
