I thought option 3 and I said so. I was told: The correct answer is option 3. The patient remains biologically high-risk despite achieving MRD negativity.
Achieving MRD negativity at a sensitivity of 10⁻⁶ is an excellent treatment outcome and is strongly associated with improved progression-free and overall survival in multiple myeloma. While MRD negativity reflects how effectively treatment has reduced the disease burden, cytogenetic abnormalities provide important information about the underlying biology of the myeloma clone.
In this patient, the presence of both t(4;14) and gain(1q) identifies biologically aggressive disease. Although deep responses such as MRD negativity can substantially improve outcomes, current evidence suggests that they do not completely eliminate the adverse prognostic impact of multiple high-risk cytogenetic abnormalities. Data from studies have shown that patients with ultra-high-risk disease can achieve high rates of MRD negativity, yet their long-term outcomes remain inferior to those of patients with standard-risk disease achieving the same depth of response.
Therefore, the most accurate interpretation is that this patient remains at increased risk of relapse despite achieving MRD negativity.
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