Imaging, QoL and Patient-Reported Outcome and Supportive Care

(OA-17) MRI Response According to MY-RADS Correlates with MRD Negativity After Induction in Newly Diagnosed Multiple Myeloma: Results from the GMMG-HD7 Trial

Wednesday, September 17, 2025

16:30 - 16:40 East Coast USA Time

Location: Room 701

Abstract Presenter(s)

Marina Hajiyianni, MD

Resident Doctor
Heidelberg Myeloma Center, Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
Heidelberg, Baden-Wurttemberg, Germany

Introduction: Flow cytometry and next-generation sequencing–based assessment of minimal residual disease (MRD) in the bone marrow (BM) represents the current gold standard for evaluating treatment response in multiple myeloma and is strongly associated with long-term survival. Nevertheless, its diagnostic scope is restricted to focal bone marrow sampling sites, such as the iliac crest, which may limit its ability to capture total disease burden in cases of spatially heterogeneous involvement. Whole-body MRI (WB-MRI) provides comprehensive, non-invasive insight into the entire disease distribution. This study aimed to compare the post-induction MRD status by next-generation flow cytometry and treatment response in WB-MRI assessed according to MY-RADS in patients with newly diagnosed transplant-eligible multiple myeloma (NDTEMM).

Methods: The GMMG-HD7 is a randomized, active-controlled, phase 3 trial investigating the efficacy of isatuximab in combination with lenalidomide, bortezomib, and dexamethasone in patients with newly diagnosed, transplant-eligible multiple myeloma (NDTEMM). 83 patients were enrolled in this imaging substudy. All patients underwent WB-MRI at baseline and after induction, and had post-induction MRD assessment by next-generation flow cytometry (cut-off 1x10^-5). WB-MRI scans were analysed using the MY-RADS protocol, a structured and standardized reporting system that scores disease burden based on diffuse infiltration, number and size of focal lesions, and presence of extramedullary or paramedullary disease across multiple body regions.

Results:

Post-induction, a statistically significant association was observed between the diffuse infiltration score and MRD status for both the whole-body (Wilcoxon rank sum test, p < 0.001) and pelvic (p = 0.001) regions, with lower scores associated with MRD negativity. Patients who showed a decrease in total whole-body MRI scores from baseline had significantly higher odds of achieving MRD negativity (p = 0.002; odds ratio [OR] = 7.68, 95% confidence interval [CI]: 2.06–28.57). Similarly, a reduction in total pelvic scores was significantly associated with MRD negativity (p < 0.001; OR = 7.09, 95% CI: 2.32–21.65). Baseline MRI scores had no prognostic effect on MRD outcomes.

Conclusions: Our analysis demonstrates that reductions in WB-MRI scores, assessed using the MY-RADS protocol, are statistically significantly associated with MRD negativity following induction therapy. These findings support the use of standardized WB-MRI as a non-invasive, whole-body imaging biomarker for response assessment and risk stratification in both clinical trials and routine practice.