Why MRD Negativity is the Modern Goal in Myeloma Treatment

In the rapidly shifting landscape of multiple myeloma treatment, the roadmap for a patient diagnosed in 2026 looks vastly different than it did even a decade ago. In a recent interview with CURE, Dr. Ajay K. Nooka, a leading expert in the field, highlighted how the evolution of therapy has moved the goalposts from simply achieving remission to pursuing a measurable cure.

Nooka is the associate director of clinical research for Winship Cancer Institute of Emory University, as well as scientific director of the Winship Data and Technology Applications Shared Resource at Winship Cancer Institute of Emory University and as director of the Myeloma Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine.

From Permutations to Powerhouse Regimens

Reflecting on the progress of the last 15 years, Nooka noted that the field has expanded from having only two primary drugs to 13 approved therapies. Today, the standard of care for newly diagnosed patients has shifted to quadruplet therapy, a four-drug regimen that typically includes CD38 antibodies, IMiDs proteasome inhibitors and steroids.

Nooka described the efficacy of these combinations as synergistic: "One plus one is not two; one plus one is five." With the addition of autologous stem cell transplants and maintenance therapy, roughly 80% of patients can now achieve a complete remission (CR).

Redefining Success: What is MRD?

While CR was once the gold standard, Nooka cautioned that it is merely a measure, not a guarantee. "Complete remission is not a cure," he explained, noting that disease often "lurks" at levels undetectable by standard tests. To address this, clinicians now utilize minimal residual disease (MRD) testing, specifically next-generation sequencing (NGS).

This sophisticated tool can detect a single myeloma cell among a million bone marrow cells. Currently, this requires a bone marrow biopsy to identify a patient’s unique "clonotype" at diagnosis and track it throughout treatment.

The Path to a Cure

Nooka emphasized that achieving this deep level of response is the necessary first step toward a functional cure. In the modern era, "cure" is increasingly defined as maintaining MRD negativity at this threshold for five years without treatment.

With the integration of newer tools like bispecific antibodies earlier in the treatment journey, the proportion of patients reaching these sustained, ultra-deep remissions is climbing. For the newly diagnosed patient, the message is clear: don't just settle for a "complete response" — aim for the depth that MRD testing can prove.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.