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Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma
Open accessAbstract
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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“Challenges are compounded by limited effective salvage treatment options3 and high attrition.4”
From Teclistamab plus Daratumumab in Relapsed or Refractory Multiple Myeloma (2026) · cites this paper as [4]
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“High treatment attrition - only 13 to 35% of patients receive four or more lines of therapy - also highlights the need to use effective therapies early. 9”
From Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma. (2023) · cites this paper as [9]
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Ttal, M. I. A., Ean, J., Dünne, A. A., Toppa, A. S., Ossi, R. G., Hilippe, P., Asassus, C., Acon, T. H. F., Orbert, N., Ayen, C. A. P., et al. (2013) · Cited by 2,161
High-Dose Chemotherapy with Hematopoietic Stem-Cell Rescue for Multiple Myeloma
Child, J. A., Morgan, G. J., Davies, F. E., Owen, R. G., Bell, S. E., Hawkins, K., Brown, J., Drayson, M. T., & Selby, P. J. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022340 · Cited by 1,768
Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Moreau, P., Miguel, J. F. S., Sonneveld, P., Mateos, M., Zamagni, E., Avet‐Loiseau, H., Hájek, R., Dimopoulos, M. A., Ludwig, H., Einsele, H., et al. (2017) · Annals of Oncology · doi:10.1093/annonc/mdx096 · Cited by 901
Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline
Mikhael, J. R., Ismaila, N., Cheung, M. C., Costello, C. L., Dhodapkar, M. V., Kumar, S. K., Lacy, M. Q., Lipe, B. C., Little, R. F., Nikonova, A., et al. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.18.02096 · Cited by 344
Multiple myeloma: patient outcomes in real‐world practice
Yong, K., Delforge, M., Driessen, C., Fink, L., Flinois, A., Gonzalez‐McQuire, S., Safaei, R., Karlin, L., Mateos, M., Raab, M. S., et al. (2016) · British Journal of Haematology · doi:10.1111/bjh.14213 · Cited by 326
Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology
Kumar, S. K., Callander, N. S., Alsina, M., Atanackovic, D., Biermann, J. S., Chandler, J. C., Costello, C., Faiman, M., Fung, H. C., Gasparetto, C., et al. (2017) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2017.0023 · Cited by 279
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Self-citationUsmani, S. Z., Ahmadi, T., Ng, Y., Lam, A., Desai, A. G., Potluri, R. C., & Mehra, M. (2016) · The Oncologist · doi:10.1634/theoncologist.2016-0104 · Cited by 139
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Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma.
San-Miguel, J., Dhakal, B., Yong, K., Spencer, A., Anguille, S., Mateos, M.-V., Fernández de Larrea, C., Martínez-López, J., Moreau, P., Touzeau, C., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2303379 · Cited by 827
Facon, T., Kumar, S. K., Plesner, T., Orlowski, R. Z., Moreau, P., Bahlis, N., Basu, S., Nahi, H., Hulin, C., Quach, H., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(21)00466-6 · Cited by 370
Self-citationIsatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma
Facon, T., Dimopoulos, M.-A., Leleu, X. P., Beksac, M., Pour, L., Hájek, R., Liu, Z., Minarik, J., Moreau, P., Romejko-Jarosinska, J., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2400712 · Cited by 284
Usmani, S. Z., Facon, T. T. F., Hungria, V., Bahlis, N. J., Venner, C. P., Braunstein, M. J., Pour, L., Martí, J. M., Basu, S., Cohen, Y. C., et al. (2025) · Nature Medicine · doi:10.1038/s41591-024-03485-7 · Cited by 152
Self-citationJagannath, S., Martin, T., Lin, Y., Cohen, A. D., Raje, N., Htut, M., Deol, A., Agha, M., Berdeja, J. G., Lesokhin, A., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-25-00760 · Cited by 138
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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)
- Venue
- BMC Cancer
- Published
- 2020-11-10
- Volume
- 20
- Issue
- 1
- Pages
- 1087-1087
- ISSN
- 1471-2407 (ISSN-L)
- 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
- gold
- doi.org
- 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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