IMWG Criteria for MRD Response and Assessment in Multiple Myeloma
NCCN Guideline Recommendations
for MRD in Multiple Myeloma
Sustained MRD-Negative
MRD negativity in the marrow (NGF or NGS, or both) and by imaging as defined below, confirmed minimum of 1 year apart. Subsequent evaluations can be used to further specify the duration of negativity
(eg, MRD-negative at 5 years)
Absence of clonal plasma cells by NGS on bone marrow aspirate in which presence of a clone is defined as less than two identical sequencing reads obtained after DNA sequencing of bone marrow aspirates using a validated method with a minimum sensitivity of 1 in 10⁵ nucleated cells or higher
Sequencing MRD-Negative
MRD negativity as defined by NGF or NGS plus disappearance of every area of increased tracer uptake found at baseline or a preceding PET/CT or decrease to less mediastinal blood pool SUV or decrease to less than that of surrounding normal tissue
Imaging plus MRD-Negative
Absence of phenotypically aberrant clonal plasma cells by NGF on bone marrow aspirates using the EuroFlow standard operation procedure for MRD detection in multiple myeloma (or validated equivalent method) with a minimum sensitivity of 1 in 10⁵ nucleated cells or higher
Flow MRD-Negative
In patients with a complete response, assessment of MRD by NGS or NGF is recommended by the NCCN Guidelines (category 2A) after induction, high-dose chemotherapy and ASCT, consolidation, and maintenance.
MRD Assessment Timing
MRD negativity in the marrow (NGF or NGS, or both) and by imaging as defined below, confirmed minimum of 1 year apart. Subsequent evaluations can be used to further specify the duration of negativity
(eg, MRD-negative at 5 years)
Sustained MRD-Negative
Absence of phenotypically aberrant clonal plasma cells by NGF on bone marrow aspirates using the EuroFlow standard operation procedure for MRD detection in multiple myeloma (or validated equivalent method) with a minimum sensitivity of 1 in 10⁵ nucleated cells or higher
Flow MRD-Negative
Absence of clonal plasma cells by NGS on bone marrow aspirate in which presence of a clone is defined as less than two identical sequencing reads obtained after DNA sequencing of bone marrow aspirates using the LymphoSIGHT platform (or validated equivalent method) with a minimum sensitivity of 1 in 10⁵ nucleated cells or higher
Sequencing MRD-Negative
MRD negativity as defined by NGF or NGS plus disappearance of every area of increased tracer uptake found at baseline or a preceding PET/CT or decrease to less mediastinal blood pool SUV or decrease to less than that of surrounding normal tissue
Imaging plus MRD-Negative
NCCN Guidelines panel recommends assessing for MRD during follow-up after shared decision making with the patient to guide assessment of prognosis.
Shared Decision-Making