# MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)

Source: https://onco.cc/terms/mrd-negativity-myeloma/  
OnCo record `mrd-negativity-myeloma` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

MRD negativity means no detectable myeloma cell among 100,000 or a million marrow cells. It is the best predictor of long survival and, since 2024, an accepted endpoint for accelerated approval.

## Summary

Measured by next-generation flow (EuroFlow) or NGS (clonoSEQ) on bone marrow, increasingly with imaging (PET) confirmation. FDA ODAC voted 12-0 in April 2024 that MRD negativity at 12 months can support accelerated approval. Sustained MRD negativity (≥12 months) is the strongest prognostic marker; MRD-guided de-escalation of maintenance is being tested (DRAMMATIC, MASTER).

## Fields

- Kind: Term
- Last checked: 2026-09-07

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Minimal_residual_disease
- IMWG consensus criteria for response and MRD assessment (Kumar et al., Lancet Oncology 2016): https://doi.org/10.1016/S1470-2045(16)30206-6

## Connected records

- cancers: [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/), [Newly diagnosed multiple myeloma, transplant-ineligible](https://onco.cc/cancers/myeloma-transplant-ineligible/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)
- technologies: [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- terms: [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/)
- key papers: [CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy](https://onco.cc/key-papers/paper-cartitude-4-cilta-cel-nejm-2023/), [CEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpoint](https://onco.cc/key-papers/paper-cepheus-dara-vrd-natmed-2025/), [International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma](https://onco.cc/key-papers/paper-kumar-lancet-oncol/), [MAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplant](https://onco.cc/key-papers/paper-maia-daratumumab-rd-nejm-2019/), [PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma](https://onco.cc/key-papers/paper-perseus-dara-vrd-transplant-nejm-2024/)
- trials: [PERSEUS](https://onco.cc/trials/perseus/)
- ideas: [MRD-guided treatment-free intervals in myeloma](https://onco.cc/ideas/idea-mrd-guided-stop-myeloma/)
- people: [S. Vincent Rajkumar](https://onco.cc/people/vincent-rajkumar/), [Shaji K. Kumar](https://onco.cc/people/shaji-kumar/)
- bottlenecks: [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- collections: [Multiple Myeloma Research Foundation (MMRF)](https://onco.cc/collections/mmrf/)
- drugs: [clonoSEQ](https://onco.cc/drugs/clonoseq/)

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