Guidelines and consensus for minimal residual disease-adapted therapy in multiple myeloma from the Pan-Pacific multiple myeloma working group.

Treatment of multiple myeloma (MM) has entered the era of deep remission-oriented therapy, where minimal residual disease (MRD) has become a key indicator for treatment response and long-term prognosis, surpassing conventional complete remission criteria. However, the optimal integration of MRD into clinical decision-making remains to be established. This expert consensus offers evidence-based guidance on redefining treatment goals in the era of CD38-based therapy, incorporating MRD status into therapeutic decisions, standardizing MRD detection, and integrating new technologies to address current challenges. The consensus supports including MRD assessment in treatment evaluation for almost all MM patients and recommends a comprehensive approach that combines bone marrow, imaging, and peripheral blood-based assessments. For patients receiving CD38-based therapy, achieving and sustaining MRD negativity is strongly linked to improved outcomes. The timing and frequency of MRD testing should be adapted to treatment phases, and CD38-based therapy may be used as part of active maintenance strategies, especially in high-risk populations. Dynamic MRD monitoring is emphasized as a critical part of disease management. Both next-generation flow and next-generation sequencing are considered interchangeable for prognostic assessment, while peripheral residual disease detection is a promising direction for future disease surveillance. This consensus provides a practical framework for integrating MRD assessment into MM clinical management. Dynamic, MRD-guided treatment strategies may enable more precise risk stratification and personalized therapy, ultimately improving long-term patient outcomes.