OAB-016: Treatment pathways for patients with multiple myeloma: a real-life study based on the French National Claim database from 2014 to 2019

Abstract

<h3>Background</h3> Multiple Myeloma (MM) disease course is a succession of remissions and relapses, which define lines of treatment. For each line, several regimens can be used. This study provides a comprehensive overview of the evolution through treatment lines of MM patients, based on the nationwide French National Health Insurance (NHI) databases, called SNDS ("Système National des Données de Santé"). These databases include hospital records, primary and secondary care, and death records of 66 million people. <h3>Methods</h3> This is a retrospective observational cohort study including all cases of multiple myeloma from 2014 to 2019 identified through the French NHI databases (SNDS). Cases were detected using a validated algorithm which was expanded to consider recent evolution of MM therapeutic management. Incident patients of 2014 and 2015 were extracted and followed up until December 31st, 2019. Treatment lines were reconstructed from 2014 to 2019 through ATLAS, an artificial intelligence algorithm adapted from the Smith-Waterman alignment sequence. Time To Next Treatment (TTNT) for each line has been estimated with a Kaplan Meier method. <h3>Results</h3> 40,747 prevalent treated patients with MM were identified in the SNDS from 2014 to 2019. This analysis involved more specifically 7,118 of these patients, including 3,557 incident patients from 2014 and 3,561 from 2015. Patients were followed until December 31st, 2019, or death. For the frontline treatment, 76% [N=5,409] had a frontline without transplant (L1 NTE) and 24% [N=1,709] had a frontline with transplant (L1 TE). Among patients with L1 NTE (resp. TE), 15% [N=827] (resp. 33% [N=560]) stayed in frontline until the end of the follow-up, 31% [N=1,682] (resp. 4% [N=71]) died after their frontline, and 54% [N=2,900] (resp. 63% [N=1,078]) switched to L2. Among patients with a L1 NTE (resp. TE) and a L2, 26% [N=764] (resp. 35% [N=378]) stayed in L2 until the end of the follow-up, 29% [N=841] (resp. 12% [N=124]) died after their L2, and 45% [N=1,295] (resp. 53% [N=576]) switched to L3. Among patients with a L1 NTE (resp. TE) and a L3, 24% [N=316] (resp. 28% [N=159]) stayed in L3 until the end of the follow-up, 28% [N=367] (resp. 19% [N=111]) died after their L3, and 47% [N=612] (resp. 53% [N=306]) switched to L4. The median TTNT for L1 NTE (resp. TE) was 2.4 (resp. 3.3) years. The overall survival rate at 5 years for patients with a L1 NTE (resp. TE) was 41% (resp. 75%). Regarding treatment sequencing, the main course of patients was as follows: frontline: V-based regimen (VMP for NTE, VTd for TE); L2: Rd; L3: Pom-dex; L4: Dara mono. <h3>Conclusions</h3> This study shows the flow of patients from frontline to L4+ and their survival rates. The study also showed that real-world data are a powerful tool to study treatment lines at a national scale and lead the way to more precise analyses of optimal therapeutic sequences, including their impact on the overall survival.