Clinical implications and predictors of MRD resurgence in ASCT-eligible patients with NDMM: a real-world study in China

AIMS: This study evaluated the clinical significance of minimal residual disease (MRD) resurgence and identified predictors of MRD loss in transplant-eligible patients with newly diagnosed multiple myeloma (NDMM). PATIENTS AND METHODS: In this retrospective single-center study, 357 transplant-eligible patients with NDMM treated between 2010 and 2024 were enrolled. Among them, 272 (76.2%) achieved MRD negativity. After excluding 11 patients without subsequent MRD evaluation, 261 patients were included in the final analysis. MRD status was serially monitored during follow-up. RESULTS: After a median follow-up of 27.0 months from first MRD negativity, 97 of 261 patients (37.2%) experienced MRD resurgence. The median time from treatment initiation to first MRD negativity was 10.3 months, and the median time from first MRD negativity to MRD resurgence was 11.8 months. Factors associated with a higher risk of MRD resurgence and/or PD included high-risk cytogenetic abnormalities, delayed achievement of MRD negativity, maintenance regimen, and low platelet count at diagnosis. Among patients with unsustained MRD negativity, 46 (47.4%) developed MRD positivity before PD. Early treatment modification after MRD resurgence was associated with longer progression-free survival. CONCLUSIONS: Identifying transplant-eligible patients with NDMM at higher risk of MRD resurgence may help guide closer follow-up and earlier treatment adjustment.