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Cited by 127Multiple Myeloma Research and TreatmentsChronic Lymphocytic Leukemia ResearchAmyloidosis: Diagnosis, Treatment, Outcomes

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Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma

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Fonseca, Rafael, Usmani, Saad Z., Mehra, Maneesha, Slavcev, Mary, He, Jianming, Cote, Sarah, Lam, Annette, Ukropec, Jon, Maiese, Eric M., Nair, Sandhya, Potluri, Ravi, Voorhees, Peter M.·2020·BMC Cancer
DOI 10.1186/s12885-020-07503-yPMC PMC7656738
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Abstract

Background: For patients with multiple myeloma (MM), each additional line of therapy (LOT) is associated with lower response rates, shorter treatment duration and treatment-free intervals, and increased rates of toxicities and comorbidities. Here, we examine frontline treatment patterns, and attrition rates by LOT among newly diagnosed MM (NDMM) patients in the United States who were eligible or ineligible for autologous stem cell transplant (ASCT). Methods: Data were identified from three US patient-level databases collectively covering the period January 2000 to September 2018. Patients had an index diagnosis of MM on or after January 1, 2007, medical and prescription insurance coverage at diagnosis, a 1-year look-back period prior to the index diagnosis, no prior malignancies in the 1-year period before index diagnosis, and had received ≥1 LOT. Results: Among patients who did not receive ASCT (non-transplant; n = 22,062), 12,557 (57%) received only 1 LOT and 9505 (43%) received > 1 LOT. Patients receiving only 1 LOT were significantly older, had higher mean Charlson Comorbidity Index (CCI) scores, and higher incidences of comorbidities. Among the 2763 patients receiving ASCT, 2184 received > 1 LOT, and 579 (21%) received only 1 LOT (ie, ASCT was the last treatment). 1682 (61%) patients received induction therapy as frontline treatment, of whom 187 (11%) also received consolidation therapy. The latter group was younger than those who received only induction therapy, had lower mean CCI scores, and comparable or lower incidences of selected comorbidities. The most common frontline therapy for non-transplant and transplant-eligible patients was bortezomib/dexamethasone and bortezomib/lenalidomide/dexamethasone, respectively. Attrition rates across all LOTs were high for non-transplant patients (range, 43–57%) and transplant patients (range, 21–37%). Treatment duration decreased by LOT for non-transplant patients and was consistent across LOTs for transplant patients. Conclusions: In this analysis, a substantial proportion of patients with NDMM who received frontline therapy did not appear to receive a subsequent LOT. These high attrition rates underscore the need to use the most optimal treatment regimens upfront rather than reserving them for later LOTs in which the clinical benefit may decrease.

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Fig. 1 Frequently used frontline treatment regimens for patients with NDMM (a) who did not receive stem cell transplant (non-transplant) and (b) who received stem cell transplant (transplant). NDMM Newly diagnosed multiple myeloma, Vd Bortezomib/dexamethasone, Rd Lenalidomide/dexamethasone, VRd Bortezomib/lenalidomide/dexamethasone, V/alkylator Bortezomib/alkylating agent, V Bortezomib, R Lenalidomide, T Thalidomide. aOther regimens include other combinations of novel agents, such as Td and VR, as well as treatment with cyclophosphamide-containing regimens
Fig. 1 Frequently used frontline treatment regimens for patients with NDMM (a) who did not receive stem cell transplant (non-transplant) and (b) who received stem cell transplant (transplant). NDMM Newly diagnosed multiple myeloma, Vd Bortezomib/dexamethasone, Rd Lenalidomide/dexamethasone, VRd Bortezomib/lenalidomide/dexamethasone, V/alkylator Bortezomib/alkylating agent, V Bortezomib, R Lenalidomide, T Thalidomide. aOther regimens include other combinations of novel agents, such as Td and VR, as well as treatment with cyclophosphamide-containing regimensCC BY · PubMed Central
Fig. 2 Mean treatment duration by LOT in patients with NDMM who did not receive stem cell transplant (non-transplant) and those who did receive stem cell transplant (transplant). LOT Line of therapy, SD Standard deviation
Fig. 2 Mean treatment duration by LOT in patients with NDMM who did not receive stem cell transplant (non-transplant) and those who did receive stem cell transplant (transplant). LOT Line of therapy, SD Standard deviationCC BY · PubMed Central

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Metadata

Authors
Fonseca, R., Usmani, S. Z., Mehra, M., Slavcev, M., He, J., Cote, S., Lam, A., Ukropec, J., Maiese, E. M., Nair, S., Potluri, R., & Voorhees, P. M.
Affiliations
  • Levine Cancer Institute (US)
  • Janssen Scientific Affairs (United States) (US)
  • Janssen (Belgium) (BE)
ORCID
Venue
BMC Cancer
Publisher
Springer Science and Business Media LLC
Published
2020-11-10
Volume
20
Issue
1
Pages
1087-1087
ISSN
1471-2407 (ISSN-L)
DOI
10.1186/s12885-020-07503-y
PMC
PMC7656738
OpenAlex
W3098371200
Cited by
127
References
20
Citations by year
2026: 21 · 2025: 33 · 2024: 26 · 2023: 25 · 2022: 16 · 2021: 5
FWCI
7.26
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cancer (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Janssen Global Services, LLC
Topics
  • Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
  • Health Sciences › Medicine › Hematology › Chronic Lymphocytic Leukemia Research
  • Health Sciences › Medicine › Internal Medicine › Amyloidosis: Diagnosis, Treatment, Outcomes
Keywords
multiple myeloma, newly diagnosed multiple myeloma, attrition rates, treatment lines, autologous stem cell transplantation, induction therapy, consolidation therapy, bortezomib, lenalidomide, dexamethasone, comorbidities, treatment duration, treatment toxicity, transplant eligibility, medication adherence
MeSH terms
Bortezomib, Lenalidomide, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Dexamethasone, Female, Follow-Up Studies, Humans, Male, Multiple Myeloma, Patient Dropouts, Prognosis, Retrospective Studies, Transplantation, Autologous, Survival Rate, Hematopoietic Stem Cell Transplantation

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