{"entity":{"id":"idea-mrd-guided-stop-myeloma","kind":"idea","name":"MRD-guided treatment-free intervals in myeloma","aka":[],"tldr":"If a patient has had no detectable myeloma for a year or more, stop maintenance and watch, restarting only if disease reappears.","summary":"For a patient with multiple myeloma whose disease has been undetectable by MRD testing for a year or more, this idea proposes stopping maintenance and watching, restarting only if disease reappears. The rationale is that sustained MRD negativity at the most sensitive threshold predicts a very low rate of relapse, that MRD re-emergence precedes clinical relapse by months, and that indefinite lenalidomide adds toxicity, second cancers and cost. The hypothesis is that stopping after twelve months of sustained MRD negativity gives non-inferior progression-free survival with better quality of life. PERSEUS, MASTER, DRAMMATIC (SWOG S1803) and GEM2014MAIN test stopping, so it is being tested at scale; it addresses the bottlenecks of dormant cells and minimal residual disease and of trial design.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03710603: PERSEUS","url":"https://clinicaltrials.gov/study/NCT03710603"}],"tags":[],"related":[],"cancers":["multiple-myeloma"],"sections":[],"technologies":["mrd-testing"],"targets":[],"drugs":["lenalidomide","daratumumab"],"companies":[],"institutions":[],"pathways":[],"terms":["mrd-negativity-myeloma"],"trials":["perseus"],"people":[],"bottlenecks":[],"keyPapers":["paper-lenalidomide-multiple-myeloma-n-engl-j-med-2016","paper-lenalidomide-multiple-myeloma-n-engl-j-med-2007","paper-lenalidomide-multiple-myeloma-n-engl-j-med-2015"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Stopping maintenance after ≥12 months sustained MRD negativity (10⁻⁶) yields non-inferior PFS at 3 years compared with continued lenalidomide, with better quality of life.","rationale":"MRD-negative CR at 10⁻⁶ carries ~90% 5-year PFS in modern cohorts; MRD re-emergence precedes clinical relapse by months, allowing pre-emptive restart.","test":"Randomised MRD-guided discontinuation with serial marrow/peripheral MRD and PET; PFS non-inferiority primary.","maturity":"being-tested-at-scale"},"route":"/ideas/idea-mrd-guided-stop-myeloma/","neighbours":{"cancer":[{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"}],"technology":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"daratumumab","kind":"drug","name":"Daratumumab","route":"/drugs/daratumumab/"},{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"}],"term":[{"id":"mrd-negativity-myeloma","kind":"term","name":"MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)","route":"/terms/mrd-negativity-myeloma/"}],"trial":[{"id":"perseus","kind":"trial","name":"PERSEUS","route":"/trials/perseus/"}],"paper":[{"id":"paper-lenalidomide-multiple-myeloma-n-engl-j-med-2015","kind":"paper","name":"Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma","route":"/key-papers/paper-lenalidomide-multiple-myeloma-n-engl-j-med-2015/"},{"id":"paper-lenalidomide-multiple-myeloma-n-engl-j-med-2016","kind":"paper","name":"Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma","route":"/key-papers/paper-lenalidomide-multiple-myeloma-n-engl-j-med-2016/"},{"id":"paper-lenalidomide-multiple-myeloma-n-engl-j-med-2007","kind":"paper","name":"Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma","route":"/key-papers/paper-lenalidomide-multiple-myeloma-n-engl-j-med-2007/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}]}}