Understanding Minimal Residual Disease (MRD) reports can be complicated. After receiving your results, you may look at the document and wonder which data points are worth paying attention to. 

Here’s a real patient test that’s been anonymized based on a clonoSEQ® test for MRD: 

1. Sample-Level MRD Result or MRD status: This is the most valuable piece of information that your test will give you. Here, it will indicate whether or not you are MRD positive or negative. In other words, it will tell you whether this test detected any myeloma cells or not.

• In the anonymized example below, the sign on the right indicates “+” or positive.
• The number of cells (59) is then reported. This means that out of the million cells analyzed from the bone marrow biopsy sample, 59 were reported to be myeloma cells. 

2. Sample-Level MRD Tracking or MRD Trend: If this is your first MRD assessment, this section might not be included in your test results. However, if you have received multiple clonoSEQ results, you will be able to track the trends of your MRD results over time, which is as important as being positive or negative. 

• This is an incredibly valuable data point for both you and your specialist. If your MRD values trend upwards over multiple sample points, it may indicate a need for more frequent testing or a treatment-decision conversation. 
• Remember that trends are more important than individual value points. Although it is stressful to see that your sample number of MRD-positive cells was higher than your last test, it doesn’t necessarily mean that action is needed or that there is an active relapse. Talk to your doctor about your concerns and decide on a realistic time point for your next MRD assessment. While it is easier said than done, over-stressing won’t help the situation or your general mindset.  

Remember that MRD-negativity gives information to you and your care team about your myeloma and how it is responding to treatment, but it is one more piece of a larger puzzle. The goal is to control your disease while maintaining your quality of life. Being MRD-negative is not the only way to achieve it. 

3. Clonal Sequences Identified or Clonality status: Your report may include several clonal sequences, indicating the presence of specific immune receptor gene rearrangements associated with your myeloma.

The main types are:

• IGH Sequences (Immunoglobulin Heavy Chain)
• IGK Sequences (Immunoglobulin Kappa Light Chain)
• IGL Sequences (Immunoglobulin Lambda Light Chain)

Multiple detected sequences could mean:

1. Persistent disease clones (if MRD is positive)
2. Subclonal evolution (if new sequences appear after treatment)
3. Ongoing immune reconstitution (if B-cell recovery is occurring)

If MRD is undetectable but sequences are still reported, that could be because some patients remain clonally detectable (low-level disease). These patients can still have good long-term outcomes, so this isn’t something to worry about. You and your doctor may consider monitoring MRD over time to see if clones persist or disappear.

Reading an MRD report can be complicated and overwhelming. Ask a member of your myeloma treatment team to simplify it for you, and remember that trends are more important than individual results. You can also find additional information about understanding your report on the test-branded site.

For instance, you can access all the guidance to understand a clonoSEQ® test by clicking the button below. 

Understanding clonoSEQ® Test