Cell-free DNA Whole Genome Sequencing for Non-Invasive Minimal Residual Disease Detection in Multiple Myeloma

Minimal residual disease (MRD) monitoring in multiple myeloma (MM) relies on invasive bone marrow (BM) biopsies, which often yield insufficient tumor material. We performed whole genome sequencing of cell-free DNA from 163 plasma samples from 51 patients to develop a non-invasive MRD classifier. BM WGS identified a median of 2,502 clonal mutations, enabling cfDNA tracking at levels comparable to BM-based MRD testing. The cfDNA classifier achieved a mean AUC of 0.86 against multiparameter flow cytometry and targeted immunoglobulin sequencing (clonoSEQ), and MRD negativity after one year of maintenance was strongly associated with two-year relapse-free survival probability (Hazard Ratio = 24), with cfDNA changes preceding clinical progression by a median of 12.6 months. To establish a BM-agnostic mode, a plasma-only classifier trained on baseline cfDNA established a mean AUC of 0.79 compared to BM clinical testing and stratified relapse risk (HR = 4.18), enabling MRD detection in patients with suboptimal BM samples. Longitudinal cfDNA profiles detected subclonal evolution in half of profiled patients. Cell-free DNA whole genome sequencing provides a sensitive, scalable, and clinically informative platform for non-invasive MRD monitoring in MM.

• Type: Whole Genome Sequencing
• Archive: European Genome-phenome Archive (EGA)