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Factors associated with second-line triplet therapy in routine care in relapsed/refractory multiple myeloma. J Clin Pharm Ther 2018 Feb;43(1):45-51 PMID: 28833305

Pubmed ID





WHAT IS KNOWN AND OBJECTIVE: Second-line therapy (SLT) trials in relapsed/refractory multiple myeloma (RRMM) report superior outcomes with triplet combinations. We sought to determine factors associated with triplet SLT in routine practice.

METHODS: A retrospective cohort with claims for MM between 01/01/2008 and 03/31/2015 was grouped by 1-2 ("doublet") or 3+ ("triplet") agent therapy. Charlson comorbidity index (CCI) and disability status; CRAB symptoms (hypercalcaemia, renal/bone disease, anaemia); and relapse risk were determined.

RESULTS: Among 623 patients, the triplet group (n=146 [23%]) was younger (65.2 vs 69.8 years) and more likely to have high-risk relapse (67% vs 50%), CRAB symptoms (94.5% vs 81.1%), triplet first-line treatment (75% vs 51%) and frontline stem cell transplant (38% vs 20%) (P<0.001 for all). In multivariate analyses, CRAB symptoms (OR: 3.22, 95% CI: 1.47, 7.10), high-risk relapse (OR: 1.71, 95% CI: 1.12, 2.62) and prior triplet therapy (OR: 2.16, 95% CI: 1.38, 3.40), but neither CCI nor disability, were associated with triplet SLT. A trend towards triplets among younger patients (<65 vs >75 years, OR: 1.73, 95% CI: 0.99, 3.04) was observed.

WHAT IS NEW AND CONCLUSION: The majority of patients did not receive triplet regimens. Treatment selection with triplet therapy for RRMM should carefully consider comorbidities and patient-specific characteristics.

Author List

Hari P, Romanus D, Henk HJ, Becker LK, Noga SJ, Morrison VA


Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin



MESH terms used to index this publication - Major topics in bold

Antineoplastic Combined Chemotherapy Protocols
Multiple Myeloma
Neoplasm Recurrence, Local
Retrospective Studies
jenkins-FCD Prod-331 a335b1a6d1e9c32173c9534e6f6ff51494143916