Fig. 7

Schematic of treatment pipeline for multiple myeloma patients. Following diagnosis, patients undergo induction therapy (for example, combination of bortezomib, lenalidomide, and dexamethasone), followed by either consolidation therapy, or in eligible patients, autologous stem cell transplant (ASCT) with consolidation. This is followed by maintenance therapy. However, even with sustained maintenance therapy, almost all patients inevitably relapse. At the time of relapse, a clinical decision is made to choose from an array of therapeutic options, including many combination therapies. To inform this decision, patient history is considered (for example, prior therapies received) combined with the physician’s clinical experience (solid lines). Response duration varies, but eventually relapse occurs, and the same process repeats. Post-relapse drug selection is where the sSMR and assaying cell MAR response would be of greatest utility, allowing more precise clinical determination of therapeutic strategy by adding an important data point to the physician’s decision-making process (dotted lines). Results of the assay could inform which drug combinations are most likely to elicit complete response, as well as potentially being linked to other clinical outcomes such as progression-free survival. In addition to the post-relapse setting, MAR response could also help inform initial selection of induction therapy, especially with the growing list of available agents, to help maximize the probability of a complete response