Abstract
Background Limited data are available from real-world practices in Europe describing prevailing treatment patterns and outcomes in relapsed/refractory multiple myeloma (RRMM), particularly by cytogenetic risk. Methods A retrospective medical record review was conducted in 200 RRMM patients in France. From first relapse, patients were assessed on second-/third-line treatments, progression-free survival (PFS), overall survival (OS), and healthcare utilization. Results Fifty-five high risk and 113 standard risk patients were identified. Overall, 192 patients (96%) received second-line therapy after relapse. Lenalidomide-based regimens were most common (>50%) in second line. Hospitalization incidence in high risk patients was approximately twice that of standard risk patients. From Kaplan-Meier estimation, median (95% CI) second-line PFS was 21.4 (17.5, 25.0) months (by high versus standard risk: 10.6 [6.4, 17.0] versus 28.7 [22.1, 37.3] months). Among second-line recipients, 47.4% were deceased at data collection. Median second-line OS was 59.4 (38.8, NE) months (by high versus standard risk: 36.5 [17.4, 50.6] versus 73.6 [66.5, NE] months). Conclusions The prognostic importance of cytogenetic risk in RRMM was apparent, whereby high (versus standard) risk patients had decidedly shorter PFS and OS. Frequent hospitalizations indicated potentially high costs associated with RRMM, particularly for high risk patients. These findings may inform economic evaluations of RRMM therapies.
Highlights
Multiple myeloma (MM) is a malignancy of clonal plasma cells
In Europe, autologous stem cell transplant (SCT) is recommended as the standard of care for patients less than 65 years old with newly diagnosed MM, which should be preceded by induction therapy aimed at quickly achieving clinical response prior to transplantation [6]
Our study found that treatment practices in real-world settings to manage relapsed MM, starting with second-line treatment, generally align with European Society for Medical Oncology (ESMO) guidelines in that lenalidomide/dexamethasone was the most commonly reported second-line regimen (53.7% of patients)
Summary
Multiple myeloma (MM) is a malignancy of clonal plasma cells. Worldwide, MM accounts for an estimated 0.8% (114,000) of all new cancer cases annually and 0.9% (63,000) of all cancer deaths annually [1, 2]. In Europe, autologous stem cell transplant (SCT) is recommended as the standard of care for patients less than 65 years old ( it is often performed in patients over the age of 65 as well) with newly diagnosed MM, which should be preceded by induction therapy aimed at quickly achieving clinical response prior to transplantation [6] Such induction usually comprises approximately four treatment cycles and available data suggest that three-agent induction regimens, containing at least one novel agent, result in higher response rates than two-agent combinations [7,8,9,10,11,12,13].
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