The REMNANT study

During EHA 2026, Dr Frida Bugge Askeland, haematologist at the Oslo Myeloma Center, presented primary results from the phase 2 portion of the REMNANT trial. REMNANT is an academic, randomized phase 2/3 study designed to investigate whether treatment initiated at measurable residual disease (MRD) relapse following first-line therapy can improve the progression-free (PFS) and overall survival of patients with multiple myeloma (MM).

The phase 2 component enrolled newly diagnosed, transplant-eligible MM patients who received a uniform treatment approach consisting of bortezomib, lenalidomide, and dexamethasone (VRD) induction, followed by single or tandem autologous stem cell transplantation and VRD consolidation. Following consolidation, patients who achieved a very good partial response or better underwent MRD assessment by flow cytometry with a sensitivity of 10^-5. The study was designed with broad eligibility criteria to reflect routine clinical practice, allowing enrollment of patients up to 75 years of age and permitting inclusion regardless of hematologic parameters, renal or liver function. Of note, patients with an Eastern Cooperative Oncology Group performance status of up to 3 were eligible as long as the impairment was attributable to MM.

A total of 382 patients were enrolled in the study. The median age was 63 years, with 40% of patients aged 65 years or older. Renal impairment was present in a fifth of patients, and 21% had high-risk cytogenetic abnormalities. Following consolidation, 33% of patients achieved an MRD-negative complete response. At 2 years, 79% of patients were free of progression, with a 2-year OS rate of 93%. Importantly, outcomes were similar in patients aged younger than 65 years and those aged 65 years or older. 

In conclusion, these findings show that standard VRD-based treatment achieves high rates of MRD-negative complete response in a patient population representative of routine clinical practice, producing comparable outcomes across age groups.