MRD Testing Could Cut Costs, Refine Blood Cancer Care: Ravi Vij, MD, MBA

Measurable residual disease (MRD) testing is becoming an increasingly important tool in managing hematologic malignancies, guiding both prognostic assessment and, in some cases, treatment decisions.

In an interview with The American Journal of Managed Care® (AJMC®), Ravi Vij, MD, MBA, professor of medicine in the Division of Medical Oncology at Washington University School of Medicine, explained how MRD testing is already predictive in acute lymphoblastic leukemia and some cases of chronic lymphocytic leukemia, while it remains primarily prognostic in multiple myeloma.

Vij emphasized that future algorithms will need to determine whether intensifying therapy for patients with MRD-positive disease or abbreviating treatment for those with sustained MRD negativity leads to better outcomes. Once sufficient data are available, Vij said MRD-guided care could help reduce costs, minimize treatment-related toxicity, and extend the durability of disease control for many patients.

This transcript has been lightly edited; captions were auto-generated.

Transcript

As MRD testing becomes more common in blood cancers, what clinical or financial changes are necessary to make MRD-guided care a standard part of treatment for all patients?

I think MRD is certainly a growing part of our patient management in a variety of hematological malignancies. In some, it is already not only prognostic, but predictive in that you can decide your course of treatment based on the results of the MRD, like in acute lymphoblastic leukemia [and] some cases of chronic lymphocytic leukemia.

In multiple myeloma, we are getting there slowly, but at the moment it's more a prognostic marker. Algorithms have to be vetted on whether giving more patients more treatment if they are MRD positive to drive them to deeper levels of response or abbreviating treatment for those who have sustained MRD negativity is going to cut down on costs and the toxicity of the treatment.

I think that we just need more data, but yes, once that becomes available it could actually reduce cost by—in several cases—reducing the duration of treatment and also potentially—in certain cases—curing more patients, or at least keeping the disease in check for longer, and therefore patients not needing alternative treatments either.