In an interview with CancerNetwork® at the 23rd Annual International Myeloma Society (IMS) Meeting & Exposition, Hans C. Lee, MD, discussed long-term disease management for patients with multiple myeloma who achieve deep, sustained minimal residual disease (MRD) negativity and move past active treatment. Lee is director of myeloma research at Sarah Cannon Research Institute (SCRI) and a medical oncologist at SCRI Oncology Partners in Nashville, Tennessee.
More patients now achieve deep, durable remissions, and some remain disease free off therapy for years, so how to follow patients once treatment stops has become a central question. The 2026 meeting featured a large sustained MRD analysis that defined an ultra-low-risk group of patients based on sustained MRD negativity, genomic risk, and disease stage, who have favorable outcomes after stopping therapy.
Lee described a surveillance approach with 4 parts: blood-based myeloma markers every 3 months, annual advanced imaging, consideration of annual bone marrow MRD assessment, and close coordination with primary care for age-appropriate cancer screening and cardiovascular health.
Transcript:
CancerNetwork: For patients who achieve deep, sustained MRD negativity, what does long-term disease management look like once they have moved past active treatment?
Lee: Recently, we have seen some substantial improvements in how patients do with our current [multiple] myeloma therapies, not only in terms of response rates, but also in durability of responses. Some of our patients are now coming off therapy based on data suggesting that, at some point, coming off maintenance therapy might be the most appropriate approach to [treating] these patients. Now, we have a new cohort of survivorship patients, which I think is a great thing to have in the [multiple] myeloma community.
In such patients, I may initially monitor a patient with their blood myeloma markers at least every 3 months. In addition, in the observation phase, I also check additional measures of potential [multiple] myeloma recurrence, including imaging. At minimum, I get advanced imaging once a year, either with a whole-body MRI or a whole-body PET-CT. I also consider a bone marrow biopsy at least annually for [MRD] assessment.
In this patient population, we also know that prior therapies can put patients at increased risk for additional cancers. It is important for patients to collaborate closely with their primary care physicians on age-appropriate cancer screening, as well as on keeping up to date with their cardiovascular health, diet, and exercise. I tell patients that we are thinking long term when it comes to [multiple] myeloma. It is not just the myeloma; we also want to make sure that their overall health is good because our patients are living longer with myeloma, which is fantastic.
