MRD Testing For Multiple Myeloma: What It Means And How It’s Used Throughout Treatment

“In the past we relied on saying the patients have no trace of cancers,” Dr. Al-Ola A Abdallah, director of plasma cell disorders at The University of Kansas Health System, tells SurvivorNet. “Now we have more techniques that can actually look at a very simple number of cells in millions of cells.”

MRD testing can now uncover disease that would have been invisible just a decade ago.

Why Does MRD Matter?

MRD status gives doctors a deeper, more precise picture of how well treatment is working.

Patients who are “MRD-negative,” meaning no cancer cells are detected even with these sensitive tools, tend to do better over time. They often stay in remission longer and may have a lower risk of relapse.

“There is a big potential that these patients could be cured,” Dr. Abdallah says.

The concept of a cure is something that was rarely discussed in multiple myeloma not long ago. MRD is one of the reasons that conversation is changing.

How is MRD Testing Done?

In most cases today, MRD testing is performed using a bone marrow biopsy, where a small sample of bone marrow is examined with highly sensitive techniques.

Doctors may check MRD at specific points throughout treatment, such as:

• After initial therapy
• After stem cell transplant
• During long-term maintenance treatment

In many centers, testing is done periodically, especially when patients are in remission.

Is MRD Changing Treatment Decisions?

This is where things get more nuanced. MRD is incredibly useful for prognosis, helping doctors estimate how a patient is likely to do, but it is not yet a universal decision-making tool in everyday practice.

In some situations, though, MRD is starting to influence care. For example, doctors are studying whether patients who remain MRD-negative for a sustained period might safely reduce or even stop treatment.

“We’re going to try to use it to guide how we stop some of the treatments … If patients stay in remission, they might not need to be on therapy for the rest of their life,” Dr. Abdallah explains.

Maintaining remission while improving quality of life is a central goal in cancer care. However, there are still important limits. If MRD becomes positive, meaning tiny amounts of cancer are detected again, it doesn’t always trigger immediate treatment changes. Many doctors take a cautious, individualized approach.

“If MRD turns positive, we don’t have really solid guidance … some physicians may wait and monitor rather than immediately change treatment,” Dr. Abdallah says.

An Evolving Role in Multiple Myeloma Care

With the rise of advanced treatments like CAR T-cell therapy and bispecific antibodies, MRD testing’s role is still evolving. After CAR T-cell therapy, for example, MRD is often used more for monitoring and reassurance than for guiding next steps.

It may be used “just to give the patient an estimation that they’re still in remission,” Dr. Abdallah says.

For patients, MRD testing is best understood as a highly sensitive measuring tool, one that helps your care team see deeper than ever before. It can provide reassurance when no disease is detected or potentially guide future decisions about reducing treatment.

The role of MRD is still being defined through ongoing clinical trials. Researchers are working to answer key questions, such as:

• When should MRD be tested?
• How often is testing needed?
• Should treatment change based on MRD alone?
• Can MRD-negative status truly define a cure?

Overall, MRD testing is part of incredible progress in multiple myeloma care over the past few decades. It’s a tool helping to move cancer care toward longer remissions, better quality of life, and, increasingly, the possibility of cure.

Questions To Ask Your Doctor

• Have I or can I undergo MRD testing?
• How often will I need to undergo testing going forward?
• How else will my treatment progress be monitored?

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