(222) Standardizing Minimum Residual Disease Testing in an Ambulatory Hematology/Oncology Clinic

Poster Abstract:

Background:
Minimum residual disease (MRD) refers to the detection of malignant cells up to 10-6, a level of cellular activity with the potential to induce relapse after apparent remission. Traditional screening methods for hematologic malignancies are unable to detect disease with such precision. The NCCN Clinical Practice Guidelines for Multiple Myeloma (MM) provide limited guidance on MRD testing and its utility, but suggest initiating MRD monitoring on the basis of shared-decision making.
MRD has been correlated with response to therapy, patient outcomes, and risk of relapse. A meta-analysis by Munshi et al. demonstrated that MRD negativity was associated with improvements in progression-free survival and overall survival in MM patients. The MASTER trial utilized MRD to adjust duration of therapy and showed patients entering treatment-free remission had low risk for relapse one year after treatment discontinuation. These studies, coupled with ongoing research, suggest a potential role for MRD testing as a clinical tool to guide treatment decisions based on patient-specific response.

Objective(s):
The aim of this quality improvement project is to develop an efficient, standardized workflow for MRD testing at a large academic medical center. Investigation will include evaluation of the effects of MRD testing on patient-specific outcomes. The complexity and lack of standardization creates potential barriers to MRD utilization in eligible patients.

Methods:
Eligibility criteria and recommended monitoring time frames have been produced to facilitate enrollment and capture all potential patients. MM is the primary malignancy identified for initial standardization. Based upon the success of the MM protocol implementation, the ultimate goal will be to include additional malignancies with future Plan-Do-Study-Act cycles.
Eligible patients being considered for stem cell transplant, with standard-risk disease expected to achieve complete response, or on maintenance therapy will be considered candidates for MRD testing per the proposed MRD testing guideline. Patients already on maintenance therapy without available baseline clone identification or bone marrow aspirate available for malignant sequencing will not be considered MRD candidates.
MRD testing will occur at baseline and at regular intervals derived from testing strategies utilized in current literature. All patients will undergo standard of care testing for disease response to clinical interventions at regular intervals in combination with MRD testing. MRD negativity will be defined as two consecutive negative MRD tests, which are required to drive decision making pertaining to abbreviation and discontinuation of therapy.

Results: Results Pending

Discussion/

Conclusion: Discussion/Conclusion Pending

References (must also be included in final poster): 1. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Multiple Myeloma Version 1.2024. 2023 Sep 22; National Comprehensive Cancer Network. Available from: https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. Accessed Sept 2, 2023.
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