Circulating tumour DNA analysis predicts relapse and improves risk stratification in primary refractory multiple myeloma

Multiple myeloma (MM), an incurable plasma cell malignancy, is the second most common form of blood cancer with a 5-year overall survival (OS) of 48.5% for newly diagnosed (ND) MM patients [ 1 ]. Prospective real-world evidence shows that 23% of NDMM patients relapse within 12 months (primary refractory) of starting bortezomib-based first-line therapy (1L) with a subsequent median OS of only 16.8 months [ 2 , 3 , 4 ]. Moreover, 15% of patients have a sub-optimal response (SOR) (<partial response but without progression) to 1L [ 3 , 4 ]. Genomic analysis of these primary refractory patients could provide prognostic insight for the design of alternative secondary treatment approaches with 1L and/or emerging novel anti-MM drugs to improve patient outcome.