MCW Cancer Center clinical research teams activated the multicenter MASTER-2 trial, led locally by Binod Dhakal, MD, Associate Professor of Hematology and Oncology. This phase II study explores a more personalized way to treat newly diagnosed multiple myeloma (MM); it uses minimal residual disease (MRD) testing to determine whether patients need a stem cell transplant or can continue therapy without it.
“MRD refers to the tiny number of cancer cells that may still remain after treatment—too small to be seen on regular tests. By using it to guide decisions, we can potentially reduce unnecessary treatment for those who are already doing well, and intensify therapy only for those who need it,” said Dr. Dhakal.
In MASTER-2, all patients begin with a combination of four drugs—daratumumab, bortezomib, lenalidomide, and dexamethasone (known as Dara-VRd)—a standard first-line treatment for MM. After six cycles, patients who are MRD-negative continue with more of the same therapy and forgo transplant, while those who are MRD-positive receive a stem cell transplant. This is followed by either standard maintenance or a novel combination that includes teclistamab, a drug that helps the immune system target myeloma cells more effectively.
“This strategy represents a significant evolution from traditional treatment models, where stem cell transplant is typically used early on for nearly all eligible patients. By tailoring treatment based on how much cancer remains after initial therapy, we aim to limit overtreatment and reduce side effects while still achieving strong outcomes,” said Dr. Dhakal, who played a significant role in the design and the development of the study.
The MCW Cancer Center is nationally recognized for its leadership in MM research. Dr. Dhakal and his team have played key roles in transformative studies, including CARTITUDE-4, which demonstrated the effectiveness of CAR T-cell therapy in patients who had received just one prior line of treatment—reshaping the standard of care and expanding access to this cutting-edge therapy. Center investigators continue to lead in this space by driving research that delivers more precise, less toxic treatments, reflecting their deep commitment to improving blood cancer outcomes.
“MASTER-2 is a natural evolution of what we’ve been working toward: smarter, safer, and more individualized care,” said Dr. Dhakal.
The trial aims to enroll 300 patients nationwide, with 30 participating at Froedtert & MCW sites.