PSY9 - REAL-WORLD EPIDEMIOLOGY, TREATMENT PATTERNS AND SURVIVAL OF MULTIPLE MYELOMA PATIENTS IN A LARGE NATIONWIDE HEALTH PLAN

Abstract

Survival of patients with multiple myeloma (MM) has improved significantly with access to autologous stem cell transplant (SCT) and new treatments. This study aims to describe the real-world epidemiology, treatment patterns and outcomes of MM. A retrospective database study was conducted in Maccabi Healthcare Services (MHS), a 2-million-member nationwide health plan in Israel. MM was defined by cross-linking data on MM diagnoses, dispensed treatments, and serum free light-chain assays. Prevalence (31/12/2016) and incidence (2012-2016) rates were age-standardized (WHO). Newly diagnosed and treated patients (2009-2015) were followed through 31/12/2016 for overall survival (OS) and cumulative incidence of progression to second-line (L2), with death as a competing risk. MM prevalence and incidence rates were 2.6 per 10,000 and 4.6 per 100,000 population, respectively. In the treatment cohort (N=552), mean (SD) age was 65.6 (11.3) years (60.1% male), with a median of 6 weeks from diagnosis to treatment. Median (95% CI) OS was 5.2 (4.3-6.1) years overall and 6.5 (4.9-8.1) years for first-line (L1) bortezomib (N=421). In a multivariable analysis adjusting for L1 regimen and patients characteristics and comorbiditeis, OS was significantly higher among patients who initiated L1 in 2012-2015 vs. 2009-2011. Within a year, 38.4% underwent SCT. Cumulative incidence of L2 was 38.2% and 51.4% within 1 and 2 years, respectively, and was associated with older age (≥65y; P<0.001). The results of this real-world analysis in a large heterogeneous population demonstrate MM incidence and survival rates that are in line with the literature, together with a significant improvement in overall survival over time. Approximately half of newly treated patients progressed to L2 within two years and older patients progressed significantly faster. These results will serve as a baseline for further research to evaluate the clinical impact of new interventions.