Adoption of triplet therapy and clinical outcomes in routine practice among newly diagnosed multiple myeloma patients not receiving frontline stem cell transplant in the USA. Issue 1 (2nd January 2019)

• Record Type: Journal Article
• Authors: Hari, Parameswaran; Blazer, Marlo; Raju, Aditya; Farrelly, Eileen; Labotka, Richard; Skacel, Tomas; Romanus, Dorothy
• Is Part Of: Expert review of hematology. Volume 12:Issue 1(2019)
• Page Start: 71
• Page End: 79
• Publication Date: 2019-01-02
• Subjects: Newly diagnosed multiple myeloma -- induction therapy -- triplet therapy; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2019.1555460
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Background : Immunomodulator (IMID) and proteasome inhibitor (PI) triplet frontline therapy (FT) in newly diagnosed multiple myeloma (NDMM) trials improve overall survival (OS); reported outcomes in routine practice are lacking. Authors compared outcomes in NDMM patients in the USA by use of triplet vs doublet FTs. Methods : In this retrospective study of NDMM patients without FT transplant between 1/1/2008 and 6/30/2017, FT was categorized as: PI+IMID-triplet (≥ 3 drugs including PI+IMID), non-PI+IMID-triplet (≥ 3 drugs, not PI+IMID), doublet (≤ 2 drugs). Univariate and multivariate analyses identified FT triplet predictors and compared time-to-next-treatment (TTNT)/OS. Results : Among 4, 982 NDMM patients, 68% and 32% initiated doublet and triplet FTs (PI+IMID: 36% in 2017). Triplet FT predictors included: age, cytogenetics, ISS stage, certain CRAB symptoms. Median TTNTPI+IMID-triplet = 18.9 months vs 13.7 (non-PI+IMID-triplet) and 16.5 months (doublet) FTs ( P < 0.01); adjusted HRPI+IMID-triplet = 0.86; P = 0.009; HRnon-PI+IMID-triplet = 1.10; P = 0.083 vs doublet FT. Median OSPI+IMID-triplet = 58.7 months vs 43.6 (non-PI+IMID-triplet) and 45.7 months (doublet) FTs ( P < 0.01); adjusted HRPI+IMID-triplet = 0.83; P = 0.016; HRnon-PI+IMID-triplet = 1.02; P = 0.727 vs doublet FT. Conclusion : PI+IMID-triplet FT is not utilized for most non-frontline-transplant NDMM patients in routine care but is associated with prolonged TTNT/OS.