Table 1.
MRD techniques for myeloma recommended by the IMWG [12]: pros and cons.
| Next-Generation Sequencing (NGS) | Next-Generation Flow (NGF) | Imaging (PET/CT) | |
|---|---|---|---|
| Availability | Adaptive Biotechnologies (Seattle, US-WA); commercial service; FDA approved; academic platforms ongoing | Worldwide | Almost all hematological centers |
| Applicability | 90–92% | Roughly 100% | 85–90% |
| Baseline assessment | Required for identification of dominant clonotype | Not required | Required for identification of focal lesions or extramedullary disease |
|
Processing
requirements |
Fresh sample is not required; both fresh and stored samples | Fresh samples are required; assessment within 24–36 h | NA |
| Standardization | Yes; Adaptive Biotechnologies (Seattle, US-WA) | Yes; EuroFlow Consortium | Ongoing [13] |
| Sample quality control | Evaluable by global bone marrow cell analysis | Not possible | NA |
| Quantitative | Yes | Yes | Yes |
| Sensitivity | 1 in 10−5–10−6 | 1 in 10−5–10−6 | Spatial resolution limit of 5 mm for focal lesions |
| Turnaround and complexity | 1–2 weeks; bioinformatic support required | 3–4 h; flow cytometry skills required; automated software available | 80–90 min for the procedure; 30 min for analysis. Requires nuclear medicine support |
| Clonal evolution | Evaluable by tracking minor clonotypes | Not evaluable | Evaluable by focal lesion biopsies |
| Patchy disease evaluation | No | No | Yes |
| Costs | Roughly 1500 USD/sample | Roughly 300 USD/sample | Roughly 1350 USD/patient |
Abbreviations. IMWG, International Myeloma Working Group; NGS, next-generation sequencing; NGF, next-generation flow; PET/CT, positron emission tomography/computed tomography; FDA, Food and Drug Administration; NA, not available; h, hours; min, minutes.