OnCo
ideasIdea

MRD-guided treatment-free intervals in myeloma

If a patient has had no detectable myeloma for a year or more, stop maintenance and watch, restarting only if disease reappears.

Sustained MRD negativity predicts very low relapse rates; indefinite lenalidomide adds toxicity, second cancers and cost. PERSEUS embedded dara discontinuation after sustained MRD negativity; MASTER, DRAMMATIC (SWOG S1803) and GEM2014MAIN test stopping.

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.
What would test it
Randomised MRD-guided discontinuation with serial marrow/peripheral MRD and PET; PFS non-inferiority primary.
Maturity
being tested at scale

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