Which is the best indicator of improved outcomes in multiple myeloma: sCR, CR, IFCR or MCR?

FAQ Library published on May 10, 2016
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Sagar Lonial, MD, FACP
Chair and Professor
Department of Hematology and Medical Oncology
Chief Medical Officer
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia

Managing Myeloma recently talked with Dr. Sagar Lonial of the Emory University School of Medicine about which is the best indicator of improved outcomes in multiple myeloma: SCR, CR, IFCR, or MCR?
[Editor’s note: Dr. Lonial’s transcript has been edited to improve readability]

This is a really important, evolving area in the field of multiple myeloma. We know, for instance, that patients who achieve a Complete Response or CR have improved progression-free and overall survival compared to patients who do not, and in fact, that group includes patients with high-risk myeloma such as 17p deletion, 4;14 translocation, or other karyotypic abnormalities. There is now emerging data suggesting that the Stringent Complete Response (SCR) also offers some benefit; validation in large phase 3 trials is currently ongoing. The two newer categories of flow cytometric complete remission and Molecular Complete Remission (MCR) are currently in evolution, and there is data again suggesting that patients that achieve IFCR or MCR do appear to have better outcomes in terms of progression-free and overall survival. However, we do not know whether those findings are truly predicative or prognostic, in the sense that perhaps we have identified the best patients who achieved molecular or flow cytometric complete remission. As such, while these certainly are important goals of therapy, achieving the deepest response one can, such as using molecular testing, next-generation sequencing, or flow cytometry to assess MRD negativity, it is not clear that one should change therapy at this time based on whether or not a patient has achieved that endpoint. Those trials asking those specific questions are currently ongoing.

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Reviewed on January 17, 2017 for clinical relevance.

Last modified: February 8, 2017
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