Minimal residual disease (MRD) refers to the small number of malignant cells below the limit of
detection available with conventional morphologic assessment.68 In multiple myeloma, MRD refers to
myeloma cells that are present in the bone marrow after a clinical response has been measured and the
patient is in remission. These residual myeloma cells are clinically relevant, as they may lead to
disease progression and relapse.20,69
The response criteria have evolved over time due to therapeutic advances in multiple myeloma. In 1998,
a conventional complete response (CR) required bone marrow aspirates with less than 5% plasma cells,
irrespective of their clonal nature. Current technology allows for further identification of myeloma
cells by expression of cell-surface markers and genomic architecture.69
*Requires a CR, which is defined as negative immunofixation on the serum and urine
and disappearance of any soft tissue plasmacytomas and < 5% plasma cells in bone marrow aspirates.
ASO-PCR, allele-specific oligonucleotide polymerase chain reaction; BM,
bone marrow; FC, flow cytometry; IF, immunofluorescence; IHC, immunohistochemistry; MM, multiple
myeloma; NGF, next-generation flow; NGS, next-generation sequencing; PC, plasma cells.
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