Faculty Collaboration Database

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. Expert Rev Hematol 2019 Jan;12(1):71-79

Date

12/05/2018

Pubmed ID

30513016

DOI

10.1080/17474086.2019.1555460

Scopus ID

2-s2.0-85058444317 (requires institutional sign-in at Scopus site)   2 Citations

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 TTNT_{PI+IMID-triplet} = 18.9 months vs 13.7 (non-PI+IMID-triplet) and 16.5 months (doublet) FTs (P< 0.01); adjusted HR_{PI+IMID-triplet} = 0.86; P= 0.009; HR_{non-PI+IMID-triplet} = 1.10; P = 0.083 vs doublet FT. Median OS_{PI+IMID-triplet} = 58.7 months vs 43.6 (non-PI+IMID-triplet) and 45.7 months (doublet) FTs (P< 0.01); adjusted HR_{PI+IMID-triplet} = 0.83; P= 0.016; HR_{non-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.

Author List

Hari P, Blazer M, Raju A, Farrelly E, Labotka R, Skacel T, Romanus D

Author

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

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

Female
Humans
Male
Multiple Myeloma
Stem Cell Transplantation
Treatment Outcome
United States